Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 010 | PR |
NPI | 1184981516 |
---|---|
Provider Name | Mr. Benigno Baez |
First Address | Corozal, PR 00783-2059 |
Second Address | Corozal, PR 00783-2059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 23/04/2012 |