Provider Demographics
NPI:1124379029
Name:PALOMARES, GREGORIO SEMILLA JR
Entity Type:Individual
Prefix:MR
First Name:GREGORIO
Middle Name:SEMILLA
Last Name:PALOMARES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S. EL CAMINO REAL
Mailing Address - Street 2:UNIT 313
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403
Mailing Address - Country:US
Mailing Address - Phone:650-286-9310
Mailing Address - Fax:650-286-9310
Practice Address - Street 1:2901 S. EL CAMINO REAL
Practice Address - Street 2:UNIT 313
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403
Practice Address - Country:US
Practice Address - Phone:650-286-9310
Practice Address - Fax:650-286-9310
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies