Provider Demographics
NPI:1801853429
Name:CABAN, CARMEN ROSA (OPTICIAN LIC 153)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ROSA
Last Name:CABAN
Suffix:
Gender:F
Credentials:OPTICIAN LIC 153
Other - Prefix:MR
Other - First Name:CATALIN
Other - Middle Name:
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN LIC 38
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1429
Mailing Address - Country:US
Mailing Address - Phone:787-872-2977
Mailing Address - Fax:787-830-3216
Practice Address - Street 1:CENTRO COMERCIAL COOP 1
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-2977
Practice Address - Fax:787-830-3216
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051831OtherMEDICARE Y MUCHO MAS CRUZ
PR54595OtherTRIPLE SSS
PR051831OtherMEDICARE Y MUCHO MAS CRUZ