Healthcare Provider Details

I. General information

NPI: 1053084954
Provider Name (Legal Business Name): ALEX PALACIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 LONG BEACH BLVD FL 2
LONG BEACH CA
90806-1558
US

IV. Provider business mailing address

6587 RANCHO DEL SOL WAY APT 17
SAN DIEGO CA
92130-5682
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-7475
  • Fax:
Mailing address:
  • Phone: 760-562-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: