Provider Demographics
NPI:1912980301
Name:LEMELL, LILLIAM CARABALLO (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:LILLIAM
Middle Name:CARABALLO
Last Name:LEMELL
Suffix:
Gender:F
Credentials:DPM, MPH
Other - Prefix:MS
Other - First Name:LILLIAM
Other - Middle Name:CARABALLO
Other - Last Name:RODRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM, MPH
Mailing Address - Street 1:PO BOX 800677
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0677
Mailing Address - Country:US
Mailing Address - Phone:787-841-2228
Mailing Address - Fax:787-841-2220
Practice Address - Street 1:TORRE SAN CRISTOBAL
Practice Address - Street 2:SUITE 213
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-841-2228
Practice Address - Fax:787-841-2220
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000030213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR48024Medicare ID - Type Unspecified
T26842Medicare UPIN