Provider Demographics
NPI:1902013022
Name:CABRERA, KYDIAN (LND)
Entity Type:Individual
Prefix:
First Name:KYDIAN
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MAJAGUA ST URB VILLA DE BUENAVENTURA
Mailing Address - Street 2:155
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9545
Mailing Address - Country:US
Mailing Address - Phone:787-266-0506
Mailing Address - Fax:
Practice Address - Street 1:AVE FONT MARTELO355
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered