Provider Demographics
NPI:1053993618
Name:DE PALMA, RUSSELL RODOLFO (CP)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:RODOLFO
Last Name:DE PALMA
Suffix:
Gender:M
Credentials:CP
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Mailing Address - Street 1:1691 GALISTEO ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4781
Mailing Address - Country:US
Mailing Address - Phone:505-820-2390
Mailing Address - Fax:505-820-2392
Practice Address - Street 1:1010 LEAD AVE SE STE 400
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5214
Practice Address - Country:US
Practice Address - Phone:505-247-0430
Practice Address - Fax:505-820-2392
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACP003517OtherAMERICAN BOARD FOR CERTIFICATION