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Individual
LUZ VIRGINIA BAEZ
Active
Individual
LUZ VIRGINIA BAEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003204A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001613119
ANTHEM PTAN
IN
01
—
074790108
MEDICARE PTAN
IN
01
—
266180H63
MEDICARE PTAN
IN
05
—
300049182
—
IN
Enumeration date
04/05/2021
Last updated
09/24/2024
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