Healthcare Provider Details

I. General information

NPI: 1972422103
Provider Name (Legal Business Name): GENESIS MARIA CARABALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 335
YAUCO PR
00698
US

IV. Provider business mailing address

2983 COSTA CORAL URB PERLA DEL SUR
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-508-9401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7997
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: