| Doctor Name: | MR. JUAN CARLOS REBOLLO |
| NPI Number: | 1427338227 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CNA |
| License Number: | NA9988812 |
| Business Practice Address: | 38 Prospect St. Apartment A6 Naugatuck, CT - 067703045 |
| Business Phone Number: | 8602187027 |
| Business Fax Number: | |
| Mailing Address: | 38 Prospect Street, Apartment A6 NAUGATUCK |
| State: | CT |
| Postal Code: | 067703045 |
| Phone Number: | 8602187027 |
| Fax Number: | |
| NPI Enumeration Date: | 08/24/2011 |
| NPI Last Update Date: | 08/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3747A0650X |
| License Number: | NA9988812 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Technician |
| Taxonomy Specialization: | Attendant Care Provider |
| Taxonomy Definition: | An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |