Provider Demographics
NPI:1699441329
Name:BAEZ, JULIO CESAR
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:BAEZ
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 1:4426 SW 8TH CT APT B
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6716
Mailing Address - Country:US
Mailing Address - Phone:239-321-4375
Mailing Address - Fax:
Practice Address - Street 1:4426 SW 8TH CT APT B
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6716
Practice Address - Country:US
Practice Address - Phone:239-321-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-181295106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician