Provider Demographics
NPI:1841735404
Name:JORGE L CARBALLO DPM PA
Entity Type:Organization
Organization Name:JORGE L CARBALLO DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARBALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-642-4777
Mailing Address - Street 1:220 CAMILO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7207
Mailing Address - Country:US
Mailing Address - Phone:305-642-4777
Mailing Address - Fax:305-642-0600
Practice Address - Street 1:1330 SW 22ND ST STE 408
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2945
Practice Address - Country:US
Practice Address - Phone:305-642-4777
Practice Address - Fax:305-642-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty