Healthcare Provider Details

I. General information

NPI: 1063739910
Provider Name (Legal Business Name): DORA PALACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD RIO HONDO MENTAL HEALTH CENTER
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

17707 STUDEBAKER ROAD RIO HONDO MENTAL HEALTH CENTER
CERRITOS CA
90703
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0688
  • Fax: 562-402-3032
Mailing address:
  • Phone: 562-402-0688
  • Fax: 562-402-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number375813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: