Provider Demographics
NPI:1396074308
Name:VALLIN, CARLOS (ARNP)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:VALLIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:VALLIN-ABREU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:8411 SW 124TH AVE
Mailing Address - Street 2:APT. 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4629
Mailing Address - Country:US
Mailing Address - Phone:305-274-2475
Mailing Address - Fax:305-274-2475
Practice Address - Street 1:3986 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7000
Practice Address - Country:US
Practice Address - Phone:305-823-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9263741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health