Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 6417 | PR |
NPI | 1194794255 |
---|---|
Provider Name | Edwin Baez Montalvo |
First Address | Bayamon, PR 00959 |
Second Address | Bayamon, PR 00959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 25/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068067 | CA (01) | |
2669 | IMC (01) | |
C77460 | (02) |