Healthcare Provider Details

I. General information

NPI: 1013049857
Provider Name (Legal Business Name): MS. DIANE PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR. VENTURA COUNTY BEH. HEALTH
OXNARD CA
93036
US

IV. Provider business mailing address

1911 WILLIAMS DR. VENTURA COUNTY BEH. HEALTH
OXNARD CA
93036
US

V. Phone/Fax

Practice location:
  • Phone: 805-814-1617
  • Fax: 805-981-4291
Mailing address:
  • Phone: 805-814-1617
  • Fax: 805-981-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: