Basic Information
| Provider Information | |||||||||
| NPI: | 1407864705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABRERA-ULLOA | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | MAYRA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CABRERA-ULLOA | ||||||||
| OtherFirstName: | MAYRA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
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| OtherCredential: | AU.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | CONDOMINIO PLAZA ANTILLANA APT. 7101 | ||||||||
| Address2: | 151 CESAR GONZALEZ | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582439 | ||||||||
| FaxNumber: | 7877985000 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 CALLE CASIA | ||||||||
| Address2: | AUDIOLOGY SERVICE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009213200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876417582 | ||||||||
| FaxNumber: | 7876410654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 12/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 061 | PR | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.