Provider Demographics
NPI:1245425313
Name:CARBALLIDO, ESTRELLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTRELLA
Middle Name:M
Last Name:CARBALLIDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESTRELLA
Other - Middle Name:M
Other - Last Name:CARBALLIDO-ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:1708 CAPE CORAL PKWY W
Practice Address - Street 2:SUITE 10
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6985
Practice Address - Country:US
Practice Address - Phone:239-541-4633
Practice Address - Fax:239-541-1825
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104845207RH0003X
AZ47455207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003834600Medicaid
FL003834600Medicaid