Individual
DR. WENDY BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
K4359
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8CC564
BLUE CROSS OF TEXAS
TX
01
—
8F22359
MEDICARE IND PTAN
TX
Enumeration date
07/12/2005
Last updated
07/21/2022
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