Provider Demographics
NPI:1992724793
Name:CABELLO, JUAN C (BA)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:C
Last Name:CABELLO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 EMETERIO HERNANDEZ
Mailing Address - Street 2:URB. PASEO DE LOS ARTESANOS
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-399-4939
Mailing Address - Fax:
Practice Address - Street 1:193 URB. PASEO DE LOS ARTESANOS
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-399-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1994099OtherDRIVER LICENCE