Provider Demographics
NPI:1780463323
Name:PALMA FUOMAN, JESUS ALBERTO
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ALBERTO
Last Name:PALMA FUOMAN
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 1:9397 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3927
Mailing Address - Country:US
Mailing Address - Phone:832-582-5447
Mailing Address - Fax:832-582-5457
Practice Address - Street 1:9397 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3927
Practice Address - Country:US
Practice Address - Phone:832-582-5447
Practice Address - Fax:832-582-5457
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily