MEDICARE: DR. MARIA ANTONIETA CARBALLOSA M.D

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	208000000X	Pediatrics Physician	ME59149	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366492845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA ANTONIETA CARBALLOSA M.D

Provider Business Mailing Address
First Line	:	4395 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4014
Country	:	US
Telephone Number	:	305-821-3944
Fax Number	:	305-821-4301

Provider Business Practice Location Address
First Line	:	4395 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4014
Country	:	US
Telephone Number	:	305-821-3944
Fax Number	:	305-821-4301

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/26/2024

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