Provider Demographics
NPI:1104353291
Name:CARABALLO, LILIAN
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 CAMINO REAL APT 104G
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7113
Mailing Address - Country:US
Mailing Address - Phone:786-306-5228
Mailing Address - Fax:
Practice Address - Street 1:7740 CAMINO REAL APT 104G
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7113
Practice Address - Country:US
Practice Address - Phone:786-306-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator