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General NPI Number Information
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NPI Number | 1437124047
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Entity Type | Individual
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Provider Name | MARIA TERESA POL-CARBALLO M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2006
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 3520 W 18TH AVE STE 115
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City | HIALEAH
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State | FL
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Zip | 33012-4634
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Country | US
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Telephone | 786-837-0897
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Fax | 786-837-0898
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Provider Business Mailing Address
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Address Line | 6100 BLUE LAGOON DR STE 365
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City | MIAMI
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State | FL
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Zip | 33126-7010
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Country | US
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Telephone | 786-322-7333
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Fax | 786-322-7329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | ME0060604
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License Number State | FL
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