Provider Demographics
NPI:1952433393
Name:CARABALLO, VIVIAN E (PT)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:E
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RES. LA CEIBA BLQ.9 APTO. 84
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-365-1652
Mailing Address - Fax:787-284-1167
Practice Address - Street 1:RES. LA CEIBA BLQ.9 APTO. 84
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-365-1652
Practice Address - Fax:787-284-1167
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3710183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3913179OtherELECTORAL