Provider Demographics
NPI:1285407866
Name:BAEZ MUNOZ, GUSTAVO ALEJANDRO
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ALEJANDRO
Last Name:BAEZ MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1019
Mailing Address - Country:US
Mailing Address - Phone:787-404-5025
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE SAN ISIDRO
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-404-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program