Provider Demographics
NPI:1538681127
Name:DIAZ CARBALLO, YUDIT (FNP)
Entity Type:Individual
Prefix:MS
First Name:YUDIT
Middle Name:
Last Name:DIAZ CARBALLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 SW 137TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7240
Mailing Address - Country:US
Mailing Address - Phone:786-234-0656
Mailing Address - Fax:
Practice Address - Street 1:7500 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122
Practice Address - Country:US
Practice Address - Phone:305-593-8355
Practice Address - Fax:305-593-8369
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9324451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner