Provider Demographics
NPI:1437486966
Name:CARABALLO, ADRIAN (RN)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 SANTA ANA AVE
Mailing Address - Street 2:#4
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5400
Mailing Address - Country:US
Mailing Address - Phone:949-310-4733
Mailing Address - Fax:949-548-8667
Practice Address - Street 1:2569 SANTA ANA AVE
Practice Address - Street 2:#4
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5400
Practice Address - Country:US
Practice Address - Phone:949-310-4733
Practice Address - Fax:949-548-8667
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613514163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent