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General NPI Number Information
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NPI Number | 1770718975
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Entity Type | Individual
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Provider Name | MARY ANN PALOMINO MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 865 3RD AVE SUITE #133
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City | CHULA VISTA
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State | CA
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Zip | 91911-1300
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Country | US
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Telephone | 619-662-4100
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Fax | 619-427-0134
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Provider Business Mailing Address
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Address Line | 4004 BEYER BLVD
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City | SAN YSIDRO
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State | CA
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Zip | 92173-2007
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Country | US
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Telephone | 619-662-4100
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Fax | 619-427-0134
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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 | A115699
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License Number State | CA
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