Provider Demographics
NPI:1023750502
Name:CARABALLO VIERA, IRADIEL
Entity type:Individual
Prefix:
First Name:IRADIEL
Middle Name:
Last Name:CARABALLO VIERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18025 NW 42ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3309
Mailing Address - Country:US
Mailing Address - Phone:786-857-4670
Mailing Address - Fax:
Practice Address - Street 1:18025 NW 42ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3309
Practice Address - Country:US
Practice Address - Phone:786-857-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician