Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP144424 | TX |
NPI | 1003454174 |
---|---|
Provider Name | Andres Baeza |
First Address | El Paso, TX 79902-5622 |
Second Address | El Paso, TX 79902-5668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2019 |
Last Update Date | 29/09/2020 |