Healthcare Provider Details

I. General information

NPI: 1427601194
Provider Name (Legal Business Name): PALOMA ALEJANDRA PICAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

324 W R ST
WILMINGTON CA
90744-1358
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-1000
  • Fax:
Mailing address:
  • Phone: 310-748-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: