Healthcare Provider Details

I. General information

NPI: 1255181368
Provider Name (Legal Business Name): FEDERICO PALACARDO BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # 7400
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

515 E 89TH ST APT 2K
NEW YORK NY
10128-7876
US

V. Phone/Fax

Practice location:
  • Phone: 917-355-0061
  • Fax:
Mailing address:
  • Phone: 917-355-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: