Provider Demographics
NPI:1104540228
Name:SEE-AVILEZ BAEZ, EESANG
Entity type:Individual
Prefix:
First Name:EESANG
Middle Name:
Last Name:SEE-AVILEZ BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 W SWEET AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8564
Mailing Address - Country:US
Mailing Address - Phone:559-679-9729
Mailing Address - Fax:
Practice Address - Street 1:3130 W SWEET AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8564
Practice Address - Country:US
Practice Address - Phone:559-679-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician