MEDICARE: MR. IVAN BAEZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA 9108132	FL
2	363A00000X	Physician Assistant	57497	CA

General Provider Information

NPI Number	:	1790062982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IVAN BAEZ PA-C

Provider Business Mailing Address
First Line	:	100 WILSON RD STE 100
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7885
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 SAN JOSE ST STE 301
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3928
Country	:	US
Telephone Number	:	831-759-3289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	05/27/2026

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