Provider Demographics
NPI:1841660800
Name:CARABALLO, YENDI (LD)
Entity type:Individual
Prefix:
First Name:YENDI
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0553
Mailing Address - Country:US
Mailing Address - Phone:787-245-7664
Mailing Address - Fax:
Practice Address - Street 1:AVE HOSTOS # 2
Practice Address - Street 2:770
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-832-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1780133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist