Provider Demographics
NPI:1275584674
Name:CABRERA-RODRIGUEZ, CARMEN R
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:CABRERA-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALLE ALMONTE APT 302
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2408
Mailing Address - Country:US
Mailing Address - Phone:787-367-9805
Mailing Address - Fax:
Practice Address - Street 1:COND TORRES DE ANDALUCIA I
Practice Address - Street 2:APT 302
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:939-499-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1201133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057178OtherMEDICARE
Q41005Medicare UPIN