Provider Demographics
NPI:1326825993
Name:PALOMINO, BRENDA (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PALOMINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E LA PASADA BLVD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1368
Mailing Address - Country:US
Mailing Address - Phone:632-772-4300
Mailing Address - Fax:623-772-4320
Practice Address - Street 1:540 E LA PASADA BLVD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1368
Practice Address - Country:US
Practice Address - Phone:632-772-4300
Practice Address - Fax:623-772-4320
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX902761163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool