Provider Demographics
NPI:1619260437
Name:PALUCH, PORNPIT NIT (LVN)
Entity Type:Individual
Prefix:MRS
First Name:PORNPIT
Middle Name:NIT
Last Name:PALUCH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 ALMOND DR
Mailing Address - Street 2:UNIT 18
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6336
Mailing Address - Country:US
Mailing Address - Phone:209-369-0541
Mailing Address - Fax:209-369-0541
Practice Address - Street 1:445 ALMOND DR
Practice Address - Street 2:UNIT 18
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6336
Practice Address - Country:US
Practice Address - Phone:209-369-0541
Practice Address - Fax:209-369-0541
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 227090164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse