MEDICARE: MRS. GWENNYTH L PALAFOX PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY20494	CA

General Provider Information

NPI Number	:	1033463153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GWENNYTH L PALAFOX PH.D

Provider Business Mailing Address
First Line	:	1001 S MARENGO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-4207
Country	:	US
Telephone Number	:	626-795-4092
Fax Number	:	626-795-9505

Provider Business Practice Location Address
First Line	:	1001 S MARENGO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-4207
Country	:	US
Telephone Number	:	626-795-4092
Fax Number	:	626-795-9505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	10/29/2012

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