Basic Information
| Provider Information | |||||||||
| NPI: | 1356982607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALOMINO | ||||||||
| FirstName: | FLORDELIN | ||||||||
| MiddleName: | YADIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1206 S ALTA VISTA AVE APT 7 | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910165224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103788643 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2021 HERNDON AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597974315 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2019 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 95012968 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.