1407864705 NPI number — DR. ROSA MAYRA CABRERA-ULLOA AU.D.

Table of content: DR. ROSA MAYRA CABRERA-ULLOA AU.D. (NPI 1407864705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407864705 NPI number — DR. ROSA MAYRA CABRERA-ULLOA AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABRERA-ULLOA
Provider First Name:
ROSA
Provider Middle Name:
MAYRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CABRERA-ULLOA
Provider Other First Name:
MAYRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407864705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CONDOMINIO PLAZA ANTILLANA APT. 7101
Provider Second Line Business Mailing Address:
151 CESAR GONZALEZ
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-2439
Provider Business Mailing Address Fax Number:
787-798-5000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CALLE CASIA
Provider Second Line Business Practice Location Address:
AUDIOLOGY SERVICE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-7582
Provider Business Practice Location Address Fax Number:
787-641-0654
Provider Enumeration Date:
08/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  061 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)