Provider Demographics
NPI:1992793970
Name:BAEZ, NORBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:NORBERTO
Middle Name:
Last Name:BAEZ
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: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:787-831-0181
Mailing Address - Fax:787-831-0181
Practice Address - Street 1:770 AVE HOSTOS
Practice Address - Street 2:POLICLINICA BELLA VISTA SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1538
Practice Address - Country:US
Practice Address - Phone:787-831-0181
Practice Address - Fax:787-831-0181
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13550207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090354Medicare ID - Type Unspecified
PRH81138Medicare UPIN