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General NPI Number Information
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NPI Number | 1811399983
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Entity Type | Organization
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Legal Business Name | MARIA A. CARBALLOSA, M.D., P.A.
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Dates
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Enumeration Date | 09/20/2014
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Last Update Date | 09/20/2014
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Provider Practice Location Address
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Address Line | 4395 PALM AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4014
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Country | US
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Telephone | 305-821-3944
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Fax | 305-821-4301
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Provider Business Mailing Address
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Address Line | 4395 PALM AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4014
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Country | US
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Telephone | 305-821-3944
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Fax | 305-821-4301
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA ANTONIETA CARBALLOSA
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Credential | M.D.
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Telephone | 305-321-6839
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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 | ME59149
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License Number State | FL
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