Healthcare Provider Details

I. General information

NPI: 1962871863
Provider Name (Legal Business Name): BLANCA MARTINEZ PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 04/02/2021
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 ROSEMEAD BLVD FIRST FLOOR
EL MONTE CA
91731-2830
US

IV. Provider business mailing address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 626-227-7001
  • Fax:
Mailing address:
  • Phone: 323-660-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: