Provider Demographics
NPI:1992579858
Name:BAEZ TOLEDO, GERALDINE MICHELLE
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:MICHELLE
Last Name:BAEZ TOLEDO
Suffix:
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 1:6049 KEMPER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6528
Mailing Address - Country:US
Mailing Address - Phone:939-649-2898
Mailing Address - Fax:
Practice Address - Street 1:6049 KEMPER LAKES DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6528
Practice Address - Country:US
Practice Address - Phone:939-649-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46112390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program