Provider Demographics
NPI:1124853254
Name:PALOMINO, MONICA LEE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:PALOMINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PASEO DEL PUEBLO SUR # 222
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5972
Mailing Address - Country:US
Mailing Address - Phone:949-870-2281
Mailing Address - Fax:
Practice Address - Street 1:26 CUCHILLA RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-8713
Practice Address - Country:US
Practice Address - Phone:949-870-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program