Provider Demographics
NPI:1225199466
Name:PALOMINO, ROSSANA CECILIA (MD)
Entity Type:Individual
Prefix:
First Name:ROSSANA
Middle Name:CECILIA
Last Name:PALOMINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:SUITE #100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-814-5170
Practice Address - Fax:425-823-5826
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4765208000000X
WAMD60247487208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047517003Medicaid
TX89500KOtherBCBS
TX89500KOtherBCBS