Healthcare Provider Details

I. General information

NPI: 1982181574
Provider Name (Legal Business Name): LETICIA PALAFOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4558
US

IV. Provider business mailing address

PO BOX 439
SANTA MARGARITA CA
93453-0439
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4275
  • Fax:
Mailing address:
  • Phone: 805-459-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAMFT159906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: