Individual
CARLOS A BACALLAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
704 WASHINGTON AVE, HOMESTEAD, FL 33030-6012
(305) 250-8758
Mailing address
167 W 23RD ST, HIALEAH, FL 33010-2211
(305) 823-3312
(305) 884-3989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ARNP9271517
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9271517
FL
Other
Enumeration date
08/21/2017
Last updated
10/03/2019
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