Provider Demographics
NPI:1407864705
Name:CABRERA-ULLOA, ROSA MAYRA (AUD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:MAYRA
Last Name:CABRERA-ULLOA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:CABRERA-ULLOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:CONDOMINIO PLAZA ANTILLANA APT. 7101
Mailing Address - Street 2:151 CESAR GONZALEZ
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-758-2439
Mailing Address - Fax:787-798-5000
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:AUDIOLOGY SERVICE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-0654
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR061231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR64018Medicare ID - Type Unspecified