Provider Demographics
NPI:1851705313
Name:PABON, JOSEVETH I
Entity Type:Individual
Prefix:
First Name:JOSEVETH
Middle Name:
Last Name:PABON
Suffix:I
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:HC 91 BOX 9059
Mailing Address - Street 2:BO. CANDELARIA CARR-647 KM-6 HC-7 CALLE ROSA SEC. RAMOS
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0031
Mailing Address - Country:US
Mailing Address - Phone:787-205-3096
Mailing Address - Fax:
Practice Address - Street 1:CARR 647 STREET ROSA
Practice Address - Street 2:HC 91 BOX 9059
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-0031
Practice Address - Country:US
Practice Address - Phone:787-205-3096
Practice Address - Fax:787-883-5465
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14613 A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4910298Medicare PIN