Provider Demographics
NPI:1083687800
Name:BAEZ MENDEZ, LUZ J (MD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:J
Last Name:BAEZ MENDEZ
Suffix:
Gender:F
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 401
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0401
Mailing Address - Country:US
Mailing Address - Phone:939-644-9364
Mailing Address - Fax:939-644-9364
Practice Address - Street 1:SIRO CARR 344 KM 0.7 INT
Practice Address - Street 2:URB COLINAS DEL ESTE C4 L10
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15135208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-06394Medicare UPIN