Provider Demographics
NPI:1700924917
Name:SANTOS CARABALLO, NORMA IRIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:IRIS
Last Name:SANTOS CARABALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 DAMASCO
Mailing Address - Street 2:URB SAN ANTONIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1606
Mailing Address - Country:US
Mailing Address - Phone:787-841-3114
Mailing Address - Fax:787-841-3114
Practice Address - Street 1:AVE PADRE NOEL # 53 PLAYA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-841-3114
Practice Address - Fax:787-841-3114
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10475208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89943Medicare ID - Type Unspecified
OTH000Medicare UPIN