Provider Demographics
NPI:1669685327
Name:CARABALLO ROSARIO, SANTOS L (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTOS
Middle Name:L
Last Name:CARABALLO ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B STREET #149 URB.RAMEY BASE
Mailing Address - Street 2:PO.BOX 250401 RAMEY BASE
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0401
Mailing Address - Country:US
Mailing Address - Phone:787-872-6756
Mailing Address - Fax:787-872-6756
Practice Address - Street 1:B STREET #149 URB.RAMEY BASE
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00604-0401
Practice Address - Country:US
Practice Address - Phone:787-872-6756
Practice Address - Fax:787-872-6756
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16732208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16732OtherSTATE MEDICAL LICENSE #