Provider Demographics
NPI:1194794255
Name:BAEZ MONTALVO, EDWIN (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:BAEZ MONTALVO
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:AVE AGUAS BUENAS
Mailing Address - Street 2:BLOQ 16 #34 URB SANTA ROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-798-0344
Mailing Address - Fax:787-740-4266
Practice Address - Street 1:AVE AGUAS BUENAS
Practice Address - Street 2:BLOQ 16 #34 URB SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-0344
Practice Address - Fax:787-740-4266
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6417207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2669OtherIMC
068067OtherCA
2669OtherIMC
26780Medicare ID - Type Unspecified