Provider Demographics
NPI:1801445572
Name:GONZALEZ PALOMINO, RAFAEL ROBERTO
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ROBERTO
Last Name:GONZALEZ 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 1:824 S. SALEM DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3449
Mailing Address - Country:US
Mailing Address - Phone:702-462-1040
Mailing Address - Fax:
Practice Address - Street 1:4550 W. OAKEY BLVD
Practice Address - Street 2:SUITE 111-0
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-861-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161065817376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker