Basic Information
Provider Information
NPI: 1407491533
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CABRERA RAMOS
FirstName: TYFANNIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
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Mailing Information
Address1: URB. PALACIOS DEL SOL
Address2: 108 AVE. PALACIOS DEL SOL
City: HUMACAO
State: PR
PostalCode: 00791
CountryCode: US
TelephoneNumber: 7875907072
FaxNumber:  
Practice Location
Address1: AVE. FONT MARTELO CENTRO COMERCIAL
Address2: EDIFICIO 10A
City: HUMACAO
State: PR
PostalCode: 00791
CountryCode: US
TelephoneNumber: 7877040705
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/13/2019
LastUpdateDate: 11/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X14749PRY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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