Provider Demographics
NPI:1942700604
Name:JURADO CARBALLO, MAYLIN
Entity Type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:JURADO CARBALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9726 NEW KENT DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1040
Mailing Address - Country:US
Mailing Address - Phone:786-230-7510
Mailing Address - Fax:
Practice Address - Street 1:9726 NEW KENT DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-1040
Practice Address - Country:US
Practice Address - Phone:786-230-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX920251163W00000X
TX1037170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse