Provider Demographics
NPI:1457516668
Name:CARBALLO-SOKOL, VIVIANA OLGA
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:OLGA
Last Name:CARBALLO-SOKOL
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 1:888 NE 126TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4964
Mailing Address - Country:US
Mailing Address - Phone:305-899-1406
Mailing Address - Fax:305-899-1352
Practice Address - Street 1:888 NE 126TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4964
Practice Address - Country:US
Practice Address - Phone:305-899-1406
Practice Address - Fax:305-899-1352
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine