Provider Demographics
NPI:1629713870
Name:PALOMINO, MARILYNN
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:PALOMINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 DECORO ST APT 50
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1411
Mailing Address - Country:US
Mailing Address - Phone:619-902-8589
Mailing Address - Fax:
Practice Address - Street 1:4178 DECORO ST APT 50
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1411
Practice Address - Country:US
Practice Address - Phone:619-902-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician