Healthcare Provider Details

I. General information

NPI: 1811399983
Provider Name (Legal Business Name): MARIA A. CARBALLOSA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 09/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4395 PALM AVE
HIALEAH FL
33012-4014
US

IV. Provider business mailing address

4395 PALM AVE
HIALEAH FL
33012-4014
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-3944
  • Fax: 305-821-4301
Mailing address:
  • Phone: 305-821-3944
  • Fax: 305-821-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59149
License Number StateFL

VIII. Authorized Official

Name: DR. MARIA ANTONIETA CARBALLOSA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-321-6839