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General NPI Number Information
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NPI Number | 1225177215
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Entity Type | Individual
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Provider Name | GREWEN BAYOT PALOMERO M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 04/02/2010
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Provider Practice Location Address
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Address Line | 1710 CHURN CREEK ROAD
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City | REDDING
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State | CA
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Zip | 96002
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Country | US
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Telephone | 530-226-0310
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Fax | 530-226-0326
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Provider Business Mailing Address
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Address Line | PO BOX 992170
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City | REDDING
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State | CA
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Zip | 96099-2170
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Country | US
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Telephone | 530-226-0310
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Fax | 530-226-0326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004-0264
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A99282
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License Number State | CA
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