Provider Demographics
NPI:1710198221
Name:CARABALLO, AIXA MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:AIXA
Middle Name:MERCEDES
Last Name:CARABALLO
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 1:6406 N IH 35
Mailing Address - Street 2:STE 2600
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4337
Mailing Address - Country:US
Mailing Address - Phone:857-523-0446
Mailing Address - Fax:
Practice Address - Street 1:1911 HETHER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3319
Practice Address - Country:US
Practice Address - Phone:857-523-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2604207R00000X
MA232142208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152486Medicare PIN