| Doctor Name: | DR. IVAN BAEZ-SANTOS |
| NPI Number: | 1073937595 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 5390 |
| Business Practice Address: | Carr. 361, Km. 1.4 Interior San German, PR - 006832318 |
| Business Phone Number: | 7876150149 |
| Business Fax Number: | |
| Mailing Address: | Po Box 2318, SAN GERMAN |
| State: | PR |
| Postal Code: | 006832318 |
| Phone Number: | 7876150149 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2014 |
| NPI Last Update Date: | 02/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 5390 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |