Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1673 | NM |
N | 111NX0100X | Occupational Health | 1673 | NM |
NPI | 1326271222 |
---|---|
Provider Name | Dr. Vincent John Palladino |
First Address | Santa Fe, NM 87501-6167 |
Second Address | Santa Fe, NM 87501-6167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2009 |
Last Update Date | 26/08/2009 |