Basic Information
| Provider Information | |||||||||
| NPI: | 1124330733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARABALLO-GONZALEZ | ||||||||
| FirstName: | IVAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CALLE CASIA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009213200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873621654 | ||||||||
| FaxNumber: | 7876414561 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 CALLE CASIA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009213200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876417582 | ||||||||
| FaxNumber: | 7876414561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 20571 | PR | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 20571 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 20571 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.