Provider Demographics
NPI:1841840246
Name:FERNANDEZ CABAN, GISELLE M
Entity type:Individual
Prefix:MISS
First Name:GISELLE
Middle Name:M
Last Name:FERNANDEZ 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:URB. VILLAS DE LOIZA
Mailing Address - Street 2:CALLE 28 TT6
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-446-5521
Mailing Address - Fax:787-727-5888
Practice Address - Street 1:PAVIA RESEARCH CENTER, LLC
Practice Address - Street 2:611 PAVIA STREET SUITE 214
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-446-5521
Practice Address - Fax:787-727-5888
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR83273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse