Individual provider Active NPI

Mary Ann Palomino, MD

  • Family Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1770718975
Registry record updated Jul 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A115699 Issued in CA
Practice address
865 3Rd Ave
Suite #133
Chula Vista, CA 91911-1300
Phone
(619) 662-4100
Fax
(619) 427-0134
NPI assigned
May 18, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A115699 CA Primary

Addresses

Primary practice location

865 3Rd Ave
Suite #133
Chula Vista, CA 91911-1300

Mailing address

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 662-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120726000313 CA Practitioner - Family Practice 2264698869 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A115699CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Jul 30, 2012 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Jul 30, 2012 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Regents of the University of California Past Accepting new patients
Grossmont Hospital Corporation Past Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Scripps Health Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients

Locations

865 Third Ave
Ste 133
Chula Vista, CA 91911
Phone (619) 205-1360

678 Third Ave
Chula Vista, CA 91910
Phone (619) 205-6349

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mpalomino18605@syhealth.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1770718975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-662-4100",
            "fax_number": "619-427-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 3RD AVE",
            "address_2": "SUITE #133",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111300",
            "telephone_number": "619-662-4100",
            "fax_number": "619-427-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALOMINO",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-18",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A115699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.