Provider Demographics
NPI:1912215054
Name:CABAN, SANDRA I
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:I
Last Name:CABAN
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:VILLAS DE FELISA 306
Mailing Address - Street 2:CECILIA V DE RALDIRIS
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:UM
Mailing Address - Phone:787-449-8809
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE FELISA 306
Practice Address - Street 2:CECILIA V DE RALDIRIS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:UM
Practice Address - Phone:787-449-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist