Provider Demographics
NPI:1710762547
Name:GARCIA CARBALLO, MARIA ELENA (DC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:GARCIA CARBALLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 AVENIDA DE LA CONSTITUCION
Mailing Address - Street 2:APT 2004
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901
Mailing Address - Country:US
Mailing Address - Phone:787-308-4056
Mailing Address - Fax:
Practice Address - Street 1:404 AVENIDA DE LA CONSTITUCION
Practice Address - Street 2:APT 2004
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-308-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor