Healthcare Provider Details

I. General information

NPI: 1053164541
Provider Name (Legal Business Name): DR. ANABEL CARBALLOSA AMOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

7146 BADGER GROVE DR
SPARKS NV
89436-1968
US

V. Phone/Fax

Practice location:
  • Phone: 813-483-9388
  • Fax:
Mailing address:
  • Phone: 813-483-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8223
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: