Provider Demographics
NPI:1548432099
Name:TORRALBA PALANCA, STELLA MARI I
Entity Type:Individual
Prefix:
First Name:STELLA MARI
Middle Name:I
Last Name:TORRALBA PALANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STELLA MARI
Other - Middle Name:I
Other - Last Name:TORRALBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-5212
Mailing Address - Fax:
Practice Address - Street 1:1185 N 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5282
Practice Address - Country:US
Practice Address - Phone:812-847-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35651207L00000X
IN01064673A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200894450Medicaid