Provider Demographics
NPI:1164188017
Name:CARABALLO DE LEON, MIGUEL (RBT)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:CARABALLO DE LEON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 AVE SAN JOSE E
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3719
Mailing Address - Country:US
Mailing Address - Phone:787-517-7970
Mailing Address - Fax:
Practice Address - Street 1:368 AVE SAN JOSE E
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3719
Practice Address - Country:US
Practice Address - Phone:787-517-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRRBT-21-173920106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician