Provider Demographics
NPI:1962423640
Name:HASKE PALOMINO, MAUREEN KITTNER (NP)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:KITTNER
Last Name:HASKE PALOMINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 VISTA DEL ORO
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3506
Mailing Address - Country:US
Mailing Address - Phone:949-200-7482
Mailing Address - Fax:949-824-3135
Practice Address - Street 1:100 IRVINE HALL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-4275
Practice Address - Country:US
Practice Address - Phone:949-824-7992
Practice Address - Fax:949-824-3135
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9289363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00NP92890OtherMEDICAL PPIN #
CA00NP92890OtherMEDICAL PPIN #
CAP61624Medicare UPIN