=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700096112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELBA M CABANILLA PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HEAD START MUNICIPIO GUAYAMA CALLE BADE PEREZ 6
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-864-2864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PARQUE DE TORRIMAR CALLE 6 F17
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-644-2698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1322
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------