Provider Demographics
NPI:1336989367
Name:CARABALLO, ROBERT WILLIAM
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:CARABALLO
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 1:975 AVE HOSTOS STE 2100
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1252
Mailing Address - Country:US
Mailing Address - Phone:787-834-2280
Mailing Address - Fax:787-834-3020
Practice Address - Street 1:975 AVE HOSTOS STE 2100
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1252
Practice Address - Country:US
Practice Address - Phone:787-834-2280
Practice Address - Fax:787-834-3020
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR846156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician