Healthcare Provider Details

I. General information

NPI: 1336327899
Provider Name (Legal Business Name): NATALEE J PALACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 SHADY GROVE RD STE 102
ROCKVILLE MD
20850-3254
US

IV. Provider business mailing address

46090 LAKE CENTER PLZ STE 102
STERLING VA
20165-5876
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-0661
  • Fax: 301-977-6940
Mailing address:
  • Phone: 703-421-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: