Healthcare Provider Details

I. General information

NPI: 1124147145
Provider Name (Legal Business Name): MARIA ESPERANZA PALACIOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA MOKADDEM MD.

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 CASCADE VALLEY CT # 105
LAS VEGAS NV
89128
US

IV. Provider business mailing address

7151 CASCADE VALLEY CT # 105
LAS VEGAS NV
89128
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-4917
  • Fax: 702-562-8680
Mailing address:
  • Phone: 702-565-4917
  • Fax: 702-562-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number11785
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: