Healthcare Provider Details

I. General information

NPI: 1669522462
Provider Name (Legal Business Name): ROBERTA MARION PALOMBI MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34859 FREDRICK ST SUITE 111
WILDOMAR CA
92595-0000
US

IV. Provider business mailing address

34859 FREDRICK ST SUITE 111
WILDOMAR CA
92595-0000
US

V. Phone/Fax

Practice location:
  • Phone: 951-678-7772
  • Fax: 951-678-4999
Mailing address:
  • Phone: 951-678-7772
  • Fax: 951-678-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 34553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: