Provider Demographics
NPI:1649809260
Name:KATHY A. CARABALLO RIVERA,PSC
Entity type:Organization
Organization Name:KATHY A. CARABALLO RIVERA,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-201-9026
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1757
Mailing Address - Country:US
Mailing Address - Phone:787-201-9026
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON MEDICAL CENTER
Practice Address - Street 2:CARR #2 KM 11.7
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-201-9026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHY A. CARABALLO RIVERA,PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty