Healthcare Provider Details

I. General information

NPI: 1750025540
Provider Name (Legal Business Name): KAMILA DE LA CARIDAD CARBALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 KINGSPOINTE PKWY
ORLANDO FL
32819-6534
US

IV. Provider business mailing address

17716 SW 146TH CT
MIAMI FL
33177-7667
US

V. Phone/Fax

Practice location:
  • Phone: 888-900-7779
  • Fax:
Mailing address:
  • Phone: 786-315-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: