Provider Demographics
NPI:1104448828
Name:PALACIOS, RAUL JR (RDN)
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:PALACIOS
Suffix:JR
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3219
Mailing Address - Country:US
Mailing Address - Phone:806-281-7562
Mailing Address - Fax:
Practice Address - Street 1:5406 COLGATE ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3205
Practice Address - Country:US
Practice Address - Phone:806-507-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85505133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered