MEDICARE: ANDREA CARBALLO FLORES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1558726703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CARBALLO FLORES

Provider Business Mailing Address
First Line	:	2959 MALLORY CIR
Second Line	:	#4305
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-1842
Country	:	US
Telephone Number	:	305-609-6290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 MALLORY CIR
Second Line	:	#4305
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-1842
Country	:	US
Telephone Number	:	305-609-6290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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Directions to “ ANDREA CARBALLO FLORES ” Practice Location

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