Provider Demographics
NPI:1851115570
Name:BAEZ MEDINA, OSWALD ANDREW
Entity type:Individual
Prefix:
First Name:OSWALD
Middle Name:ANDREW
Last Name:BAEZ MEDINA
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 1:2009 GRANDE CT APT 810
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3127
Mailing Address - Country:US
Mailing Address - Phone:321-437-4601
Mailing Address - Fax:
Practice Address - Street 1:3201 BUDINGER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7203
Practice Address - Country:US
Practice Address - Phone:407-498-4079
Practice Address - Fax:407-624-5681
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-392283106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician