Provider Demographics
NPI:1265870760
Name:PALLOMINA, MALVIN U (NP)
Entity type:Individual
Prefix:MR
First Name:MALVIN
Middle Name:U
Last Name:PALLOMINA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1913
Mailing Address - Country:US
Mailing Address - Phone:661-325-7000
Mailing Address - Fax:661-325-7050
Practice Address - Street 1:2811 H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1913
Practice Address - Country:US
Practice Address - Phone:661-325-7000
Practice Address - Fax:661-325-7050
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 22947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 22947OtherBOARD OF REGISTERED NURSING
CANPF 22947OtherBOARD OF REGISTERED NURSING, FURNISHING NUMBER