Basic Information
| Provider Information | |||||||||
| NPI: | 1548432099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORRALBA PALANCA | ||||||||
| FirstName: | STELLA MARI | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TORRALBA | ||||||||
| OtherFirstName: | STELLA MARI | ||||||||
| OtherMiddleName: | I | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1185 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128475212 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1185 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128472281 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 03/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35651 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 01064673A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200894450 | 05 | IN | MEDICAID |