Healthcare Provider Details

I. General information

NPI: 1538073648
Provider Name (Legal Business Name): LIZ DANIELA CARBALLO ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17220 NW 77TH CT
HIALEAH FL
33015-3818
US

IV. Provider business mailing address

17220 NW 77TH CT
HIALEAH FL
33015-3818
US

V. Phone/Fax

Practice location:
  • Phone: 954-548-9979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1159146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: