Healthcare Provider Details

I. General information

NPI: 1992794366
Provider Name (Legal Business Name): ANA CABEZAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT SUITE 508
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

81 CALLE REINA ALEXANDRA VILLA DE TORRIMAR
GUAYNABO PR
00969-3273
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-3737
  • Fax:
Mailing address:
  • Phone: 787-790-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16222
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: