Provider Demographics
NPI:1912169053
Name:PALLADINO, HUMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:PALLADINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7618
Mailing Address - Country:US
Mailing Address - Phone:915-590-7900
Mailing Address - Fax:915-590-7902
Practice Address - Street 1:10175 GATEWAY BLVD W
Practice Address - Street 2:SUITE 210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7618
Practice Address - Country:US
Practice Address - Phone:915-590-7900
Practice Address - Fax:915-590-7902
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1046252086S0122X
TXBP20019087208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281643103Medicaid
MNENROLLEDMedicaid
8CU427OtherBCBS OF TEXAS
TX281643103Medicaid
MN240000361Medicare PIN