Healthcare Provider Details

I. General information

NPI: 1841104395
Provider Name (Legal Business Name): JUAN GABRIEL CARABALLO SOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12608 STATE RD
NORTH ROYALTON OH
44133-3281
US

IV. Provider business mailing address

4028 DARTFORD RD
SOUTH EUCLID OH
44121-2302
US

V. Phone/Fax

Practice location:
  • Phone: 939-312-8432
  • Fax: 440-345-3456
Mailing address:
  • Phone: 939-312-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: