Healthcare Provider Details

I. General information

NPI: 1699646745
Provider Name (Legal Business Name): JUAN PALACIOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 N PERRY ST
BAYTOWN TX
77521-1077
US

IV. Provider business mailing address

215 GAGE DR STE J
HOLLISTER MO
65672-4000
US

V. Phone/Fax

Practice location:
  • Phone: 929-410-5754
  • Fax:
Mailing address:
  • Phone: 929-410-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JUAN PALACIOS
Title or Position: OWNER
Credential:
Phone: 929-410-5754