Provider Demographics
NPI:1578698940
Name:CARABALLO-GONZALEZ, EDNA JANISSE (PA)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:JANISSE
Last Name:CARABALLO-GONZALEZ
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:1802 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1431
Practice Address - Country:US
Practice Address - Phone:210-924-2337
Practice Address - Fax:210-923-2208
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2024-03-29
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Provider Licenses
StateLicense IDTaxonomies
TXPA15283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant