Provider Demographics
NPI:1316921497
Name:PALENCIA BICALDO, DOMINGO ROLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:ROLANDO
Last Name:PALENCIA BICALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DOMINGO
Other - Middle Name:ROLANDO-PALENCIA
Other - Last Name:BICALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 NIGHTINGALE RD BLDG 5525
Mailing Address - Street 2:
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93524-5312
Mailing Address - Country:US
Mailing Address - Phone:661-277-2145
Mailing Address - Fax:
Practice Address - Street 1:55 N WOLFE AVE BLDG 3925
Practice Address - Street 2:
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-5312
Practice Address - Country:US
Practice Address - Phone:609-754-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38811208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation