Provider Demographics
NPI:1104980135
Name:BAEZ, SALVADOR M (MD)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:M
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6343 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1605
Mailing Address - Country:US
Mailing Address - Phone:323-560-0600
Mailing Address - Fax:323-560-0432
Practice Address - Street 1:6343 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1605
Practice Address - Country:US
Practice Address - Phone:323-560-0600
Practice Address - Fax:323-560-0432
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435820Medicaid
CAA43582Medicare ID - Type Unspecified
CAB50511Medicare UPIN