Provider Demographics
NPI:1558356873
Name:TRUJILLO-CABRERA, CARMEN NEREIDA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:NEREIDA
Last Name:TRUJILLO-CABRERA
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:URB. SABANERA #172
Mailing Address - Street 2:CAMINO POMARROSAS
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-745-4384
Mailing Address - Fax:787-745-4788
Practice Address - Street 1:CARR. 172 KM. 7.0 BO. CANABONCITO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-745-4384
Practice Address - Fax:787-745-4788
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRS83546Medicare UPIN
PR87116Medicare ID - Type UnspecifiedPROVEEDOR