Provider Demographics
NPI:1568492817
Name:GALBAN, CARLOS JUAN (PA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:JUAN
Last Name:GALBAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4253
Mailing Address - Country:US
Mailing Address - Phone:305-285-2172
Mailing Address - Fax:305-285-2779
Practice Address - Street 1:3663 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4253
Practice Address - Country:US
Practice Address - Phone:305-285-2172
Practice Address - Fax:305-285-2779
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2758039BMedicare PIN
NCP45681Medicare UPIN