1124379029 NPI number — MR. GREGORIO SEMILLA PALOMARES JR.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124379029 NPI number — MR. GREGORIO SEMILLA PALOMARES JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALOMARES
Provider First Name:
GREGORIO
Provider Middle Name:
SEMILLA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124379029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 S. EL CAMINO REAL
Provider Second Line Business Mailing Address:
UNIT 313
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-286-9310
Provider Business Mailing Address Fax Number:
650-286-9310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 S. EL CAMINO REAL
Provider Second Line Business Practice Location Address:
UNIT 313
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-286-9310
Provider Business Practice Location Address Fax Number:
650-286-9310
Provider Enumeration Date:
10/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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