Individual
JESSICA SUSAN CARBALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
BLDG 390 N LOOP RD, FORT IRWIN, CA 92310
(760) 383-5155
Mailing address
390 N LOOP RD, FORT IRWIN, CA 92310
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
RN60857557
WA
367A00000X
Advanced Practice Midwife
Primary
AP61176629
WA
Other
Enumeration date
01/05/2021
Last updated
08/02/2024
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