Active NPI
Sofia Medina Caraballo
- Endodontics
- San Juan, PR
National Provider Identifier
1164982971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 3446
- Practice address
- 1738 Calle Amarillo Summit Building
207B
San Juan, PR 00926 - Phone
- (718) 630-7000
- NPI assigned
- Mar 20, 2019
- Last updated
- Dec 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 3446 | PR | Primary |
Addresses
Primary practice location
1738 Calle Amarillo Summit Building
207B
San Juan, PR 00926
Mailing address
1738 Calle Amarillo Summit Building
Box 16
San Juan, PR 00926
Phone (787) 472-4567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3446 | PR | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670803200000",
"number": "1164982971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1738 CALLE AMARILLO SUMMIT BUILDING",
"address_2": "BOX 16",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "00926",
"telephone_number": "787-472-4567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1738 CALLE AMARILLO SUMMIT BUILDING",
"address_2": "207B",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "00926",
"telephone_number": "718-630-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA CARABALLO",
"first_name": "SOFIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-20",
"last_updated": "2022-12-12",
"certification_date": "2022-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "PR",
"license": "3446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.