Provider Demographics
NPI:1023683224
Name:CABRERA MELENDEZ, VIVIAN
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:CABRERA MELENDEZ
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:PO BOX 5103-196
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-951-3245
Mailing Address - Fax:787-851-2625
Practice Address - Street 1:100 BOQUERON BAY VILLAS
Practice Address - Street 2:APT 605
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622-9742
Practice Address - Country:US
Practice Address - Phone:787-951-3245
Practice Address - Fax:787-851-2625
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR418-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR418-PAOtherMEDICAL LICENSE NUMBER