Provider Demographics
NPI:1619489549
Name:CARABALLO LOPEZ, DANELIA
Entity Type:Individual
Prefix:
First Name:DANELIA
Middle Name:
Last Name:CARABALLO LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 W 43RD PL APT 301
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7641
Mailing Address - Country:US
Mailing Address - Phone:786-406-5773
Mailing Address - Fax:
Practice Address - Street 1:1471 W 43RD PL APT 301
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7641
Practice Address - Country:US
Practice Address - Phone:786-406-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician