Healthcare Provider Details

I. General information

NPI: 1801467477
Provider Name (Legal Business Name): ROBERT PALLAIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 VIA SORPRESA
SAN DIEGO CA
92124-2221
US

IV. Provider business mailing address

4350 VIA SORPRESA
SAN DIEGO CA
92124-2221
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-1617
  • Fax:
Mailing address:
  • Phone: 858-565-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: