Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME87046 | FL |
NPI | 1043229164 |
---|---|
Provider Name | Dr. Mario R Palomino |
First Address | Miami, FL 33126-7010 |
Second Address | Hialeah, FL 33012-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263813401 | (05) | FL |
H67658 | (02) | FL |