Provider Demographics
NPI:1164021846
Name:PALOMERA, AHIDE
Entity Type:Individual
Prefix:
First Name:AHIDE
Middle Name:
Last Name:PALOMERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1148
Mailing Address - Country:US
Mailing Address - Phone:510-318-6100
Mailing Address - Fax:510-830-3318
Practice Address - Street 1:1005 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1148
Practice Address - Country:US
Practice Address - Phone:510-318-6100
Practice Address - Fax:510-830-3318
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist