Healthcare Provider Details

I. General information

NPI: 1497100143
Provider Name (Legal Business Name): JUAN JOSE PALACIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date: 12/30/2016
Reactivation Date: 05/18/2017

III. Provider practice location address

6431 FANNIN ST STE MSB 3228
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

1611 NW 12 AVENUE
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5650
  • Fax: 713-500-0588
Mailing address:
  • Phone: 305-585-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: