Provider Demographics
NPI:1497337174
Name:PALOMINO, MAYKEL RODOLFO (APRN)
Entity Type:Individual
Prefix:
First Name:MAYKEL
Middle Name:RODOLFO
Last Name:PALOMINO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 NW 134TH PL # 11181974
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2261
Mailing Address - Country:US
Mailing Address - Phone:786-709-7054
Mailing Address - Fax:
Practice Address - Street 1:823 NW 134TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2261
Practice Address - Country:US
Practice Address - Phone:786-709-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111627900Medicaid
FL2Q047OtherBCBS FL