Healthcare Provider Details

I. General information

NPI: 1538329164
Provider Name (Legal Business Name): ROSAMAR CARABALLO LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 509
LUQUILLO PR
00773-0509
US

IV. Provider business mailing address

PO BOX 509
LUQUILLO PR
00773-0509
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-1872
  • Fax:
Mailing address:
  • Phone: 787-889-1872
  • Fax: 787-534-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17152
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: