Provider Demographics
NPI:1518146075
Name:CABOT, BRENDA IVETTE
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:IVETTE
Last Name:CABOT
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:ST. 3 D-1 URB. SANTA ELENA
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-873-4936
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTA ELENA #3 D-1
Practice Address - Street 2:CARR 363 KM 1.7 BO. LA MAQUINA
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4896183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4896OtherSATE LICENSE