Healthcare Provider Details

I. General information

NPI: 1891037677
Provider Name (Legal Business Name): DALIZ LISSET PALACIOS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 49TH ST
HIALEAH FL
33012-3713
US

IV. Provider business mailing address

9950 SW 24TH TER
MIAMI FL
33165-2644
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-8444
  • Fax:
Mailing address:
  • Phone: 305-510-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: