Healthcare Provider Details

I. General information

NPI: 1902717317
Provider Name (Legal Business Name): JAVIERA PAZ PALMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 LOCUS ST
MODESTO CA
95351
US

IV. Provider business mailing address

2200 STANDIFORD AVE APT 201
MODESTO CA
95350-6556
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-1500
  • Fax: 209-574-1570
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: