Provider Demographics
NPI:1811399983
Name:MARIA A. CARBALLOSA, M.D., P.A.
Entity Type:Organization
Organization Name:MARIA A. CARBALLOSA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANTONIETA
Authorized Official - Last Name:CARBALLOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-321-6839
Mailing Address - Street 1:4395 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4014
Mailing Address - Country:US
Mailing Address - Phone:305-821-3944
Mailing Address - Fax:305-821-4301
Practice Address - Street 1:4395 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4014
Practice Address - Country:US
Practice Address - Phone:305-821-3944
Practice Address - Fax:305-821-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty