Provider Demographics
NPI:1144589011
Name:CABAN, ADELAIDA (LND)
Entity Type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:
Last Name:CABAN
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 CALLE JESUS RAMOS
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4576
Mailing Address - Country:US
Mailing Address - Phone:787-509-7401
Mailing Address - Fax:
Practice Address - Street 1:536 AVE VICTORIA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4623
Practice Address - Country:US
Practice Address - Phone:787-509-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1342133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist