Healthcare Provider Details

I. General information

NPI: 1174569743
Provider Name (Legal Business Name): PALMERO ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 SOLACE PL
MOUNTAIN VIEW CA
94040-4309
US

IV. Provider business mailing address

2530 SOLACE PLACE
MOUNTAIN VIEW CA
94040-4309
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-6161
  • Fax: 650-967-7878
Mailing address:
  • Phone: 650-961-6161
  • Fax: 650-967-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000410
License Number StateCA

VIII. Authorized Official

Name: MR. SHANE MCCORMACK
Title or Position: OWNER
Credential:
Phone: 650-961-6161