Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | PA9111440 | FL |
NPI | 1003394545 |
---|---|
Provider Name | Lyanne Marie Caraballo |
First Address | Pittsburgh, PA 15232-1302 |
Second Address | Pittsburgh, PA 15235-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 01/10/2020 |