Provider Demographics
NPI:1104632850
Name:CARBALLO RODRIGUEZ, JUAN MIGUEL (RN)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MIGUEL
Last Name:CARBALLO RODRIGUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18037 FM 529 RD STE C
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:281-861-5180
Mailing Address - Fax:281-861-5928
Practice Address - Street 1:21454 VENETO HILLS CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-0400
Practice Address - Country:US
Practice Address - Phone:832-897-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX965202163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health