Provider Demographics
NPI:1801213988
Name:CARABALLO, EMANUEL (CPHT)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR-36 BOX 1390-040
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-239-6222
Mailing Address - Fax:787-982-6767
Practice Address - Street 1:300 CALLE TAPIA
Practice Address - Street 2:ESQ GILBERTO MONROIG
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-239-6222
Practice Address - Fax:787-982-6767
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9661183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician