Healthcare Provider Details

I. General information

NPI: 1740513209
Provider Name (Legal Business Name): CRISTINA ESMERALDA PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WOODSIDE AVE BLDG W-3
SAN FRANCISCO CA
94127-1221
US

IV. Provider business mailing address

2807 HARRISON ST
SAN FRANCISCO CA
94110-4116
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-7784
  • Fax:
Mailing address:
  • Phone: 415-298-5757
  • 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: