Provider Demographics
NPI:1114747524
Name:PALACIOS ROMERO, MAURICIO (NP)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:PALACIOS ROMERO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4279 W 27TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4696
Mailing Address - Country:US
Mailing Address - Phone:928-366-9225
Mailing Address - Fax:
Practice Address - Street 1:1950 W 3RD ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1812
Practice Address - Country:US
Practice Address - Phone:928-276-4477
Practice Address - Fax:928-276-4481
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ239288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily