Provider Demographics
NPI:1821318015
Name:CARABALLO, NORIMAR (LND)
Entity Type:Individual
Prefix:MRS
First Name:NORIMAR
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO DE REYES 33
Mailing Address - Street 2:CALLE REY FELIPE
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-236-0594
Mailing Address - Fax:
Practice Address - Street 1:PASEO DE REYES 33
Practice Address - Street 2:CALLE REY FELIPE
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-236-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1575133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered