MEDICARE: CALLIE CARABALLO RDMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician	137076	FL

General Provider Information

NPI Number	:	1073491494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE CARABALLO RDMS

Provider Business Mailing Address
First Line	:	2701 LOS ALAMOS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-2837
Country	:	US
Telephone Number	:	432-288-4567
Fax Number	:	817-971-0070

Provider Business Practice Location Address
First Line	:	252 S ELM ST STE A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2258
Country	:	US
Telephone Number	:	817-381-2002
Fax Number	:	817-971-0070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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Directions to “ CALLIE CARABALLO RDMS” Practice Location

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