Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 181 | LA |
NPI | 1578620662 |
---|---|
Provider Name | Dr. Anthony J Palombo |
First Address | Lake Charles, LA 70601-9605 |
Second Address | Lake Charles, LA 70601-9605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |