Provider Demographics
NPI:1306148150
Name:SORIA-PALACIOS, ELIZABETH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:SORIA-PALACIOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5047
Mailing Address - Country:US
Mailing Address - Phone:626-857-2580
Mailing Address - Fax:
Practice Address - Street 1:1365 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5047
Practice Address - Country:US
Practice Address - Phone:626-857-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21249363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical