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General NPI Number Information
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NPI Number | 1750677282
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Entity Type | Individual
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Provider Name | MELISSA RICHARDSON CARABALLO D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 3028 4TH ST STE A&B
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City | MARIANNA
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State | FL
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Zip | 32446-2127
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Country | US
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Telephone | 850-718-2886
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Fax | 850-633-5908
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Provider Business Mailing Address
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Address Line | 4250 HOSPITAL DR
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City | MARIANNA
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State | FL
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Zip | 32446-1917
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Country | US
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Telephone | 850-718-2886
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Fax | 850-718-2891
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS 12572
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License Number State | FL
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