Healthcare Provider Details

I. General information

NPI: 1770705600
Provider Name (Legal Business Name): OLIVERIO PALACIOS SA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXEMPLA CIRCLE
LAFAYETTE CO
80026
US

IV. Provider business mailing address

2800 W 103RD AVE #1314
FEDERAL HEIGHTS CO
80260
US

V. Phone/Fax

Practice location:
  • Phone: 303-743-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: