Healthcare Provider Details

I. General information

NPI: 1255114419
Provider Name (Legal Business Name): JENNIFER TORRES CARABALLO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO SAN VICENTE CALLE CONCORDIA 8169 SUITE 106
PONCE PR
00717
US

IV. Provider business mailing address

VILLA NORMA CALLE EMANUEL 270
JUANA DIAZ PR
00795-2868
US

V. Phone/Fax

Practice location:
  • Phone: 787-671-1970
  • Fax:
Mailing address:
  • Phone: 787-630-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number91
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: