Provider Demographics
NPI:1679711535
Name:PALACIOS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PALACIOS
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 1:4000 LA RICA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3163
Mailing Address - Country:US
Mailing Address - Phone:626-430-9171
Mailing Address - Fax:626-430-9177
Practice Address - Street 1:2636 LEXINGTON AVE SPC 9
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2343
Practice Address - Country:US
Practice Address - Phone:626-448-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42900126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant