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General NPI Number Information
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NPI Number | 1457955544
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Entity Type | Individual
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Provider Name | LUBIN HERNANDEZ PALOMINO
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 8894 STANFORD BLVD STE 303
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City | COLUMBIA
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State | MD
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Zip | 21045-5165
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Country | US
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Telephone | 703-201-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 2441 COPPER MOUNTAIN TER
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City | SILVER SPRING
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State | MD
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Zip | 20906-6229
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Country | US
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Telephone | 703-201-3149
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04050
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License Number State | MD
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