Provider Demographics
NPI:1710244181
Name:CARABALLO, MARICELIS (PHARM TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MARICELIS
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:PHARM TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 03 BOX38146
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9720
Mailing Address - Country:US
Mailing Address - Phone:787-754-2525
Mailing Address - Fax:787-282-4726
Practice Address - Street 1:HOSPITAL INDUSTRIAL
Practice Address - Street 2:CENTRO MEDICO DE RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5028
Practice Address - Country:US
Practice Address - Phone:787-754-2525
Practice Address - Fax:787-282-7426
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6315183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDRIVER LICENSEOther4488759