Provider Demographics
NPI:1114815560
Name:RODRIGUEZ CARABALLO, MARICARMEN
Entity type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:RODRIGUEZ CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 CALLE SAN MARCOS
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-2554
Mailing Address - Country:US
Mailing Address - Phone:787-543-6526
Mailing Address - Fax:
Practice Address - Street 1:361 CALLE SAN MARCOS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-2554
Practice Address - Country:US
Practice Address - Phone:787-543-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist