Individual
MR. JUAN CARLOS REBOLLO II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNA
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
NA9988812
CT
376K00000X
Nurse's Aide
Primary
NA9988812
CT
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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