Provider Demographics
NPI:1609883164
Name:RODRIGUEZ-CARABALLO, ONEIDA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ONEIDA
Middle Name:
Last Name:RODRIGUEZ-CARABALLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0571
Mailing Address - Country:US
Mailing Address - Phone:787-899-8006
Mailing Address - Fax:787-899-8006
Practice Address - Street 1:65 DE INFANTERIA & VICTORIA ST.
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-0000
Practice Address - Country:US
Practice Address - Phone:787-899-8006
Practice Address - Fax:787-899-8006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89203Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER