RAUL E. CARBALLOSA AND ASSOCIATES, M.D'S, P.A.
Medical Practice at 40 St, Miami, FL

License number
Florida ME47929
Category
Medical Practice
Type
Specialist
Owner
Name: RAUL E CARBALLOSA MD
Title: PRESIDENT
Phone: (941) 391-4549
Address
Address
11760 SW 40Th St SUITE 306, Miami, FL 33175
National Provider ID: 1225387798
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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RAUL E. CARBALLOSA AND ASSOCIATES, M.D.'S, PA

Miami, FL  -  Punta Gorda, FL

Status:
Inactive
Inactive reason:
REINSTATEMENT
Registration:
Jun 21, 1994
Inactive since:
Oct 22, 2001
Addresses:
10405 SW 25 St, Miami, FL 33165 (Physical)
Punta Gorda, FL 33951 (Mailing)
PO Box 510730, Punta Gorda, FL 33951
State ID:
P94000046442
Business type:
Florida Profit Corporation
Director:
Raul Emd Carballosa (Director), 10405 SW 25 St, Miami, FL 33165 (Physical)
Agent:
Raul Carballosa,10405 SW 25 St, Miami, FL 33165 (Physical)
EIN:
650504022

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