Provider Demographics
NPI:1992146948
Name:CARABALLO FONSECA, JULINE NATALIA (MD)
Entity type:Individual
Prefix:
First Name:JULINE
Middle Name:NATALIA
Last Name:CARABALLO FONSECA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:130 STONY POINT RD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4120
Mailing Address - Country:US
Mailing Address - Phone:707-525-0211
Mailing Address - Fax:707-525-0491
Practice Address - Street 1:130 STONY POINT RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4120
Practice Address - Country:US
Practice Address - Phone:707-525-0211
Practice Address - Fax:707-525-0491
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-155471207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology