Provider Demographics
NPI:1871267880
Name:PEREZ CARABALLO, PEDRO ANTONIO (MA, MS)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:PEREZ CARABALLO
Suffix:
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4782
Mailing Address - Country:US
Mailing Address - Phone:787-788-4544
Mailing Address - Fax:787-788-4544
Practice Address - Street 1:166 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4782
Practice Address - Country:US
Practice Address - Phone:787-788-4544
Practice Address - Fax:787-788-4544
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program