Provider Demographics
NPI:1366794141
Name:CARABALLO MARTINEZ, EIMAELIS (ADN)
Entity type:Individual
Prefix:MS
First Name:EIMAELIS
Middle Name:
Last Name:CARABALLO MARTINEZ
Suffix:
Gender:F
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-1149
Mailing Address - Country:US
Mailing Address - Phone:787-996-0807
Mailing Address - Fax:
Practice Address - Street 1:BO CARACOLES 2
Practice Address - Street 2:PARCERA 468
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-996-0807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18294376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide