MEDICARE: DR. JORGE LUIS CARBALLO D.P.M.

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	213E00000X	Podiatrist	PO0002773	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	:	1609896687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE LUIS CARBALLO D.P.M.

Provider Business Mailing Address
First Line	:	220 CAMILO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-7207
Country	:	US
Telephone Number	:	305-642-4777
Fax Number	:	305-642-0600

Provider Business Practice Location Address
First Line	:	1330 SW 22ND ST STE 408
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2945
Country	:	US
Telephone Number	:	305-642-4777
Fax Number	:	305-642-0600

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/09/2022

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Directions to “ DR. JORGE LUIS CARBALLO D.P.M.” Practice Location

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