Healthcare Provider Details

I. General information

NPI: 1841848561
Provider Name (Legal Business Name): VICTORIA PALLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 PAN AMERICAN FWY NE APT 185
ALBUQUERQUE NM
87107-4716
US

IV. Provider business mailing address

4308 PAN AMERICAN FWY NE APT 185
ALBUQUERQUE NM
87107-4716
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-9145
  • Fax:
Mailing address:
  • Phone: 505-358-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: