Provider Demographics
NPI:1619426004
Name:TEMBONI CARABALLO, NATALIA (OD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:TEMBONI CARABALLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SUNSET HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3219
Mailing Address - Country:US
Mailing Address - Phone:480-776-4162
Mailing Address - Fax:
Practice Address - Street 1:622 SUNSET HILL DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3219
Practice Address - Country:US
Practice Address - Phone:480-776-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33589152W00000X
TX9557TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist