Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101028859 | VA |
NPI | 1043305311 |
---|---|
Provider Name | Dr. Toti Palma Gonzalo |
First Address | Newport News, VA 23608 |
Second Address | Newport News, VA 23608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BO6986 | (02) |