Basic Information
| Provider Information | |||||||||
| NPI: | 1891022273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALILEO | ||||||||
| FirstName: | KRISTINE YVETTE | ||||||||
| MiddleName: | BARONA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 J ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958113120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163410575 | ||||||||
| FaxNumber: | 9163419040 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 CAPITOL AVE DEPT 300 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162629370 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA20528 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA20528 | 01 | CA | LICENSE | OTHER |