Provider Demographics
NPI:1174784672
Name:BAEZ, GLENDALY (PT)
Entity type:Individual
Prefix:MRS
First Name:GLENDALY
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:PT
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 346
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0346
Mailing Address - Country:US
Mailing Address - Phone:787-883-2913
Mailing Address - Fax:787-270-2593
Practice Address - Street 1:HC 83 BOX 6204
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9706
Practice Address - Country:US
Practice Address - Phone:787-883-2913
Practice Address - Fax:787-270-2593
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2478183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician