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NPI Code Detail

MEDICARE: TANYA CARABALLO LCSW

MEDICARE: TANYA CARABALLO LCSW
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
11041C0700XClinical Social Worker67621CA

General Provider Information

NPI Number : 1790107068
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA CARABALLO LCSW
Provider Business Mailing Address
First Line : 1045 9TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-5504
Country : US
Telephone Number : 619-235-2600
Fax Number :
Provider Business Practice Location Address
First Line : 1045 9TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-5504
Country : US
Telephone Number : 619-235-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2014
Last Update Date : 09/25/2015

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Directions to “ TANYA CARABALLO LCSW” Practice Location

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