Healthcare Provider Details

I. General information

NPI: 1265649412
Provider Name (Legal Business Name): YAZMIN PABON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117-A1 CALLE 73B VILLA CAROLINA
CAROLINA PR
00985-4121
US

IV. Provider business mailing address

P O BOX 3240
CAROLINA PR
00984-3240
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-4940
  • Fax: 787-257-1234
Mailing address:
  • Phone: 787-762-4940
  • Fax: 787-257-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1585
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: