Provider Demographics
NPI:1144900739
Name:CARABALLO RIVERA, EMMANUELLE JOSE (MSC)
Entity type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:JOSE
Last Name:CARABALLO RIVERA
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G18C CALLE 6
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1405
Mailing Address - Country:US
Mailing Address - Phone:787-366-8384
Mailing Address - Fax:
Practice Address - Street 1:G18C CALLE 6
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1405
Practice Address - Country:US
Practice Address - Phone:787-366-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program