Provider Demographics
NPI:1538144241
Name:PALENCIA, DON D (DO)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:D
Last Name:PALENCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31685 TEMECULA PARKWAY
Mailing Address - Street 2:STE B
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-676-8868
Mailing Address - Fax:951-676-9619
Practice Address - Street 1:31685 TEMECULA PARKWAY
Practice Address - Street 2:STE B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-676-8868
Practice Address - Fax:951-676-9619
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH66112Medicare UPIN