Healthcare Provider Details

I. General information

NPI: 1154970259
Provider Name (Legal Business Name): EMILY FAY PALACIO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 12/03/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

9449 IMPERIAL HWY
DOWNEY CA
90242-2814
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-4821
  • Fax: 562-657-4895
Mailing address:
  • Phone: 562-657-4821
  • Fax: 562-657-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013307
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95013307
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number622723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: