Provider Demographics
NPI:1851555031
Name:CARABALLO, YESSI (MD)
Entity Type:Individual
Prefix:DR
First Name:YESSI
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE B-228
Mailing Address - Street 2:URB SANTA ISIDRA
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0000
Mailing Address - Country:US
Mailing Address - Phone:787-616-4940
Mailing Address - Fax:
Practice Address - Street 1:AVE B-228
Practice Address - Street 2:URB SANTA ISIDRA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0000
Practice Address - Country:US
Practice Address - Phone:787-616-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17151208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice