Basic Information
| Provider Information | |||||||||
| NPI: | 1679520373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAIZA | ||||||||
| FirstName: | ROLAND | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6071 E WOODMEN RD | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809232607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194420808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6071 E WOODMEN RD | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809232607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194420808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | DR.0040599 | CO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | 40599 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 22329382 | 05 | CO | MEDICAID |