Provider Demographics
NPI:1861911042
Name:BAEZ, CORALYS BARBARA
Entity type:Individual
Prefix:MISS
First Name:CORALYS
Middle Name:BARBARA
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 6621
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-9097
Mailing Address - Country:US
Mailing Address - Phone:787-378-3524
Mailing Address - Fax:
Practice Address - Street 1:CARR 412 KM 3.4
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-9097
Practice Address - Country:US
Practice Address - Phone:787-378-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10413183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician