Provider Demographics
NPI:1538329164
Name:CARABALLO LOPEZ, ROSAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSAMAR
Middle Name:
Last Name:CARABALLO LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 AVE B
Mailing Address - Street 2:SANTA ISIDRA
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4987
Mailing Address - Country:US
Mailing Address - Phone:787-860-2231
Mailing Address - Fax:
Practice Address - Street 1:228 AVE B
Practice Address - Street 2:SANTA ISIDRA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4987
Practice Address - Country:US
Practice Address - Phone:787-860-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17152208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice