Provider Demographics
NPI:1518712017
Name:JABONILLO, RICA ELOPRE (RPT)
Entity Type:Individual
Prefix:
First Name:RICA
Middle Name:ELOPRE
Last Name:JABONILLO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 NOSTRAND AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2549
Mailing Address - Country:US
Mailing Address - Phone:240-887-2659
Mailing Address - Fax:
Practice Address - Street 1:615 AVENUE C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4101
Practice Address - Country:US
Practice Address - Phone:718-633-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty