Provider Demographics
NPI:1922087238
Name:PALOMARES, VICTOR (PA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:PALOMARES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 N GRANT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8431
Mailing Address - Country:US
Mailing Address - Phone:970-624-5170
Mailing Address - Fax:970-669-7521
Practice Address - Street 1:3850 N GRANT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8431
Practice Address - Country:US
Practice Address - Phone:970-624-5170
Practice Address - Fax:970-669-7521
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO611363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY127998000Medicaid
CO11424770Medicaid
800937Medicare ID - Type Unspecified
S31325Medicare UPIN
CO11424770Medicaid