Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E5626 | CA |
NPI | 1033759709 |
---|---|
Provider Name | Igal Palma |
First Address | Stockton, CA 95206-3215 |
Second Address | Stockton, CA 95206-3215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2020 |
Last Update Date | 29/10/2021 |