Provider Demographics
NPI:1144317702
Name:BAEZ-SORIA, OSCAR (MD)
Entity type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:
Last Name:BAEZ-SORIA
Suffix:
Gender:M
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 194800
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4800
Mailing Address - Country:US
Mailing Address - Phone:787-807-5672
Mailing Address - Fax:787-807-5671
Practice Address - Street 1:URBANIZACION VILLA REAL CALLE
Practice Address - Street 2:2C #1A
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-807-5672
Practice Address - Fax:787-807-5671
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR147902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21860Medicare ID - Type Unspecified
PRH95363Medicare UPIN