Provider Demographics
NPI:1669245833
Name:DIAZ CARABALLO, KATHERINE MILAGROS (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MILAGROS
Last Name:DIAZ CARABALLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 10123
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-9220
Mailing Address - Country:US
Mailing Address - Phone:178-751-4052
Mailing Address - Fax:
Practice Address - Street 1:JIMENEZ ARRIBA CARR.966 KM.3.7
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-514-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical