Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DTP502 | FL |
NPI | 1770747966 |
---|---|
Provider Name | Dr. Mitzi Johanna Palazzolo |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 06/01/2022 |