Provider Demographics
NPI:1174524748
Name:CARBALLEIRA, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:CARBALLEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 194327
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4327
Mailing Address - Country:US
Mailing Address - Phone:787-743-5848
Mailing Address - Fax:787-743-8855
Practice Address - Street 1:Q36 AVE MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6158
Practice Address - Country:US
Practice Address - Phone:787-743-5848
Practice Address - Fax:787-743-8855
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D34209Medicare UPIN