Provider Demographics
NPI:1558185405
Name:EALO, CARMEN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:EALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 NW 87TH LN
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-5624
Mailing Address - Country:US
Mailing Address - Phone:786-213-5391
Mailing Address - Fax:
Practice Address - Street 1:11633 NW 87TH LN
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-5624
Practice Address - Country:US
Practice Address - Phone:786-213-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other