Provider Demographics
NPI:1982277471
Name:PALMA, LIBNA ZURISADAI (OD)
Entity Type:Individual
Prefix:DR
First Name:LIBNA
Middle Name:ZURISADAI
Last Name:PALMA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1300 W OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5678
Practice Address - Country:US
Practice Address - Phone:805-737-1169
Practice Address - Fax:805-737-1772
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1041152W00000X
CA35129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist