Healthcare Provider Details

I. General information

NPI: 1366983702
Provider Name (Legal Business Name): VINCENT PALMIERI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2017
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 W SACK DR STE 240
GLENDALE AZ
85308-7719
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-3363
  • Fax:
Mailing address:
  • Phone: 602-933-3124
  • Fax: 404-778-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number86104
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number71998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: