Basic Information
| Provider Information | |||||||||
| NPI: | 1629271184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALERMO | ||||||||
| FirstName: | COROMOTO | ||||||||
| MiddleName: | ANGELA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PALERMO GAROFALO | ||||||||
| OtherFirstName: | COROMOTO | ||||||||
| OtherMiddleName: | ANGELA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 680 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542414084 | ||||||||
| FaxNumber: | 8774046043 | ||||||||
| Practice Location | |||||||||
| Address1: | 17751 SW 2ND ST | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330293924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542414084 | ||||||||
| FaxNumber: | 8774046043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | ME125317 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 17776 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | 26240 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 17776 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME125317 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.