Provider Demographics
NPI:1649058843
Name:FUNDORA CARABALLO, JOHAN ORLANDO (MS SLP)
Entity type:Individual
Prefix:
First Name:JOHAN
Middle Name:ORLANDO
Last Name:FUNDORA CARABALLO
Suffix:
Gender:M
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8828 NW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4534
Mailing Address - Country:US
Mailing Address - Phone:305-680-9627
Mailing Address - Fax:
Practice Address - Street 1:8828 NW 112TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4534
Practice Address - Country:US
Practice Address - Phone:305-680-9627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist