Healthcare Provider Details

I. General information

NPI: 1467743542
Provider Name (Legal Business Name): HUMBERTO PALLADINO MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 GATEWAY BLVD W 210
EL PASO TX
79925-7618
US

IV. Provider business mailing address

5959 GATEWAY BLVD W 120
EL PASO TX
79925-3331
US

V. Phone/Fax

Practice location:
  • Phone: 915-590-7900
  • Fax: 915-590-7902
Mailing address:
  • Phone: 915-779-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberN8437
License Number StateTX

VIII. Authorized Official

Name: HUMBERTO PALLADINO
Title or Position: DIRECTOR
Credential: MD
Phone: 507-722-1192