MEDICARE: PEDRO ANTONIO PEREZ CARABALLO PSYD

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	103TC0700X	Clinical Psychologist	8828	PR

General Provider Information

NPI Number	:	1871267880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO ANTONIO PEREZ CARABALLO PSYD

Provider Business Mailing Address
First Line	:	PO BOX 9809
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9809
Country	:	US
Telephone Number	:	787-704-0705
Fax Number	:	787-744-7444

Provider Business Practice Location Address
First Line	:	431 AVE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3014
Country	:	US
Telephone Number	:	787-704-0705
Fax Number	:	787-744-7444

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

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	07/01/2026

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