Provider Demographics
NPI:1891490637
Name:SORIANO CARABALLO, JENLIS YAJAIRA (MD)
Entity Type:Individual
Prefix:
First Name:JENLIS
Middle Name:YAJAIRA
Last Name:SORIANO 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 1:311 CALLE PIO BAROJA URB. EL SENORIAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6910
Mailing Address - Country:US
Mailing Address - Phone:787-905-6845
Mailing Address - Fax:
Practice Address - Street 1:311 CALLE PIO BAROJA URB. EL SENORIAL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6910
Practice Address - Country:US
Practice Address - Phone:787-905-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program