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1750677282 NPI number — MELISSA RICHARDSON CARABALLO D.O.

NPI Number: 1750677282
Health Care Provider/Practitioner: MELISSA RICHARDSON CARABALLO D.O.

Information about “1750677282” NPI (MELISSA RICHARDSON CARABALLO D.O.) exists in 1750677282 in HTML format HTML  |  1750677282 in plain Text format TXT  |  1750677282 in PDF (Portable Document Format) PDF  |  1750677282 in an XML format XML  formats.

NPI Number : 1750677282 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750677282",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CARABALLO",
    "FirstName": "MELISSA",
    "MiddleName": "RICHARDSON",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MILITO",
    "OtherFirstName": "MELISSA",
    "OtherMiddleName": "RICHARDSON",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "D.O.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4250 HOSPITAL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARIANNA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32446-1917",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-718-2886",
    "MailingAddressFaxNumber": "850-718-2891",
    "FirstLinePracticeLocationAddress": "3028 4TH ST STE A&B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MARIANNA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32446-2127",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-718-2886",
    "PracticeLocationAddressFaxNumber": "850-633-5908",
    "EnumerationDate": "06/23/2011",
    "LastUpdateDate": "03/03/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "OS 12572",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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