Provider Demographics
NPI:1093366718
Name:CARABALLO, YEIDYS YADIRA
Entity Type:Individual
Prefix:
First Name:YEIDYS
Middle Name:YADIRA
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO MONTE GRANDE
Mailing Address - Street 2:307 CALLE AMALIA
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-638-9271
Mailing Address - Fax:
Practice Address - Street 1:BO MONTE GRANDE
Practice Address - Street 2:307 CALLE AMALIA
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-638-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider