Provider Demographics
NPI:1316206287
Name:CABAN, MARIMAR (LCDA)
Entity Type:Individual
Prefix:MISS
First Name:MARIMAR
Middle Name:
Last Name:CABAN
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. JARDINES DE ARROYO
Mailing Address - Street 2:CALLE OC-64
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714
Mailing Address - Country:US
Mailing Address - Phone:787-630-3199
Mailing Address - Fax:
Practice Address - Street 1:ENRIQUE GONZALEZ # 3 E
Practice Address - Street 2:
Practice Address - City:GUAYMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-242-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist