Provider Demographics
NPI:1184662926
Name:PALOMIN, OMAR (PT)
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:PALOMIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LINDBERG AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2924
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-618-1342
Practice Address - Street 1:2502 W FREDDY GONZALEZ DR
Practice Address - Street 2:SUITE B
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7387
Practice Address - Country:US
Practice Address - Phone:956-381-1600
Practice Address - Fax:956-381-1616
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1139541OtherLICENSE NUMBER
TX161273101Medicaid
TX1139541OtherLICENSE NUMBER
TXP95120Medicare UPIN