Provider Demographics
NPI:1811424641
Name:GORGOY CARABALLO, YUDITH
Entity Type:Individual
Prefix:
First Name:YUDITH
Middle Name:
Last Name:GORGOY CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 TAYLOR ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4456
Mailing Address - Country:US
Mailing Address - Phone:786-406-5431
Mailing Address - Fax:
Practice Address - Street 1:2200 TAYLOR ST APT 305
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4456
Practice Address - Country:US
Practice Address - Phone:786-406-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician