Provider Demographics
NPI:1194720078
Name:CARBALLO, PEDRO PABLO (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:PABLO
Last Name:CARBALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:STE #2-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:786-275-9755
Mailing Address - Fax:786-275-9754
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:STE #2-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:786-275-9755
Practice Address - Fax:786-275-9754
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME59878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194720078OtherNPI
FL370306100Medicaid
14709POtherMEDICARE PTAN
FL1194720078OtherNPI
FLC39459Medicare UPIN