Provider Demographics
NPI:1508344268
Name:CARBALLOSA VERDECIA, ISBEIDIS
Entity Type:Individual
Prefix:
First Name:ISBEIDIS
Middle Name:
Last Name:CARBALLOSA VERDECIA
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 1:1060 W 74TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4657
Mailing Address - Country:US
Mailing Address - Phone:786-370-7881
Mailing Address - Fax:
Practice Address - Street 1:1060 W 74TH ST APT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4657
Practice Address - Country:US
Practice Address - Phone:786-370-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician