Provider Demographics
NPI:1730393091
Name:BAEZ, RENIER A (PH D)
Entity type:Individual
Prefix:DR
First Name:RENIER
Middle Name:A
Last Name:BAEZ
Suffix:
Gender:M
Credentials:PH D
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 362604
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2604
Mailing Address - Country:US
Mailing Address - Phone:787-469-6271
Mailing Address - Fax:787-765-5533
Practice Address - Street 1:1228 CALLE PIRINEO
Practice Address - Street 2:URB. MONTERREY
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-1418
Practice Address - Country:US
Practice Address - Phone:787-469-6271
Practice Address - Fax:787-765-5533
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist