MEDICARE: THAO PALACIO

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95040166	CA

General Provider Information

NPI Number	:	1497681951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO PALACIO

Provider Business Mailing Address
First Line	:	920 OLIVE AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4810
Country	:	US
Telephone Number	:	714-210-9265
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 OLIVE AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4810
Country	:	US
Telephone Number	:	714-210-9265
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ THAO PALACIO ” Practice Location

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