Provider Demographics
NPI:1144216680
Name:CARABALLO, EDUARDO
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CALLE MATTEI LLUBERAS
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3635
Mailing Address - Country:US
Mailing Address - Phone:787-856-3525
Mailing Address - Fax:787-856-3525
Practice Address - Street 1:520 CALLE MADRID
Practice Address - Street 2:MANSIONES DE MONTERREY
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-2565
Practice Address - Country:US
Practice Address - Phone:787-856-3525
Practice Address - Fax:787-856-3525
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice