Provider Demographics
NPI:1194503557
Name:BAEZ, IRIS GABRIELA I
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:GABRIELA
Last Name:BAEZ
Suffix:I
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 1:300 INTERNATIONAL PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5000
Mailing Address - Country:US
Mailing Address - Phone:629-216-2007
Mailing Address - Fax:
Practice Address - Street 1:883 SEVEN OAKS BLVD.
Practice Address - Street 2:STE.850 SMRYNA,TN 37167
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6862
Practice Address - Country:US
Practice Address - Phone:629-216-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician