Provider Demographics
NPI:1285050971
Name:CABAN JIMENEZ, WANDA
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:CABAN JIMENEZ
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 872
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0872
Mailing Address - Country:US
Mailing Address - Phone:787-514-3336
Mailing Address - Fax:
Practice Address - Street 1:BO ALTOZANO
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:UM
Practice Address - Phone:787-514-3336
Practice Address - Fax:178-789-5839
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8339183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician