Healthcare Provider Details

I. General information

NPI: 1528459856
Provider Name (Legal Business Name): MARIA T. POL-CARBALLO, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 W 21ST CT SUITE #301
HIALEAH FL
33016-3946
US

IV. Provider business mailing address

6450 W 21ST CT SUITE #301
HIALEAH FL
33016-3946
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-6999
  • Fax: 305-820-9279
Mailing address:
  • Phone: 305-820-6999
  • Fax: 305-820-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0060604
License Number StateFL

VIII. Authorized Official

Name: DR. MARIA T POL-CARBALLO
Title or Position: OWNER/DOCTOR
Credential: M.D,
Phone: 305-820-6999