Provider Demographics
NPI:1063739910
Name:PALACIO, DORA
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:PALACIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17707 STUDEBAKER ROAD
Mailing Address - Street 2:RIO HONDO MENTAL HEALTH CENTER
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-402-0688
Mailing Address - Fax:562-402-3032
Practice Address - Street 1:17707 STUDEBAKER RD
Practice Address - Street 2:RIO HONDO MENTAL HEALTH CENTER
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2640
Practice Address - Country:US
Practice Address - Phone:562-402-0688
Practice Address - Fax:562-402-3032
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375813163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
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