Healthcare Provider Details

I. General information

NPI: 1144277526
Provider Name (Legal Business Name): ALMA M PALISOC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 E 2ND ST
SAN BERNARDINO CA
92408-0118
US

IV. Provider business mailing address

1454 E 2ND ST
SAN BERNARDINO CA
92408-0118
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7146
  • Fax: 909-382-7101
Mailing address:
  • Phone: 909-382-7146
  • Fax: 909-382-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL1403
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11958
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2312
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA101303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: