Provider Demographics
NPI:1821363318
Name:TORRES CARBALLO, ANGEL L
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:TORRES CARBALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 NW 35TH ST
Mailing Address - Street 2:APT 8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5873
Mailing Address - Country:US
Mailing Address - Phone:786-337-5748
Mailing Address - Fax:
Practice Address - Street 1:2368 NW 35TH ST
Practice Address - Street 2:APT 8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5873
Practice Address - Country:US
Practice Address - Phone:786-337-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist