Provider Demographics
NPI:1326641366
Name:CASABLANCA, ANAELI (OD)
Entity Type:Individual
Prefix:DR
First Name:ANAELI
Middle Name:
Last Name:CASABLANCA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA PAULA
Mailing Address - Street 2:#IA2 CALLE 2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-613-7886
Mailing Address - Fax:
Practice Address - Street 1:WALMART CENTRO VISUAL
Practice Address - Street 2:AVE. WEST MAIN 501
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-2088
Practice Address - Fax:787-269-2090
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist