Provider Demographics
NPI:1386426765
Name:VILLANUEVA CARABALLO, ALBERT WILLIAM
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:WILLIAM
Last Name:VILLANUEVA 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 1:4 URB SAN RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4604
Mailing Address - Country:US
Mailing Address - Phone:787-245-3249
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL OFFICES PARK IV 997 SAN ROBERTO STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-773-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI46040390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program