1003274002 NPI number — MRS. MARIA GABRIELA DELGADO CARABALLO D.D.S.

Table of content: MRS. MARIA GABRIELA DELGADO CARABALLO D.D.S. (NPI 1003274002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003274002 NPI number — MRS. MARIA GABRIELA DELGADO CARABALLO D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELGADO CARABALLO
Provider First Name:
MARIA
Provider Middle Name:
GABRIELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARABALLO
Provider Other First Name:
MARIA
Provider Other Middle Name:
GABRIELA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003274002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100415
Provider Second Line Business Mailing Address:
1395 CENTER DR., RM. D9-6
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-5850
Provider Business Mailing Address Fax Number:
352-846-1643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 CENTER DR RM D9-6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-0415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-5850
Provider Business Practice Location Address Fax Number:
352-846-1643
Provider Enumeration Date:
02/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DTP630 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102721700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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