Healthcare Provider Details

I. General information

NPI: 1871267880
Provider Name (Legal Business Name): PEDRO ANTONIO PEREZ CARABALLO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 AVE HOSTOS
SAN JUAN PR
00918-3014
US

IV. Provider business mailing address

PO BOX 9809
CAGUAS PR
00726-9809
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax: 787-744-7444
Mailing address:
  • Phone: 787-704-0705
  • Fax: 787-744-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8828
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: