Provider Demographics
NPI:1164522116
Name:PALOMENO, GLADYS ENCARNACION (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:ENCARNACION
Last Name:PALOMENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28633 S WESTERN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0817
Mailing Address - Country:US
Mailing Address - Phone:424-264-5286
Mailing Address - Fax:424-264-5409
Practice Address - Street 1:28633 S WESTERN AVE STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0817
Practice Address - Country:US
Practice Address - Phone:424-264-5286
Practice Address - Fax:424-264-5409
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67651207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH96457Medicare UPIN