Provider Demographics
NPI:1457955544
Name:HERNANDEZ PALOMINO, LUBIN
Entity Type:Individual
Prefix:
First Name:LUBIN
Middle Name:
Last Name:HERNANDEZ PALOMINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 COPPER MOUNTAIN TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6229
Mailing Address - Country:US
Mailing Address - Phone:703-201-3149
Mailing Address - Fax:
Practice Address - Street 1:8894 STANFORD BLVD STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5165
Practice Address - Country:US
Practice Address - Phone:703-201-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist