Provider Demographics
NPI:1093561631
Name:CARVALHO, JOAO
Entity type:Individual
Prefix:
First Name:JOAO
Middle Name:
Last Name:CARVALHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2835
Mailing Address - Country:US
Mailing Address - Phone:401-728-5920
Mailing Address - Fax:
Practice Address - Street 1:626 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2835
Practice Address - Country:US
Practice Address - Phone:401-728-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
201666172V00000X
RI133NN1002X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty