Provider Demographics
NPI:1538791736
Name:BAEZ DE JESUS, VICTOR REUBEN (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:REUBEN
Last Name:BAEZ DE JESUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:REUBEN
Other - Last Name:BAEZ DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:373 SEC MELENDEZ
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-2104
Mailing Address - Country:US
Mailing Address - Phone:786-520-8545
Mailing Address - Fax:
Practice Address - Street 1:3535 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5087
Practice Address - Country:US
Practice Address - Phone:786-520-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000652363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical