1003615485 NPI number — VALERY MARIE CARABALLO RIVERA PA

Table of content: VALERY MARIE CARABALLO RIVERA PA (NPI 1003615485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003615485 NPI number — VALERY MARIE CARABALLO RIVERA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARABALLO RIVERA
Provider First Name:
VALERY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003615485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 10258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENUELAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00624-9725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-512-5654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 C. FERROCARRIL BLDG
Provider Second Line Business Practice Location Address:
SANTA MARIA MEDICAL BUILDING SUITE 302
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00731-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-6669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2025

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: 363AM0700X , with the licence number:  2480P.A. , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com