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General NPI Number Information
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NPI Number | 1063739910
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Entity Type | Individual
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Provider Name | DORA PALACIO
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Gender | Female
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 17707 STUDEBAKER RD RIO HONDO MENTAL HEALTH CENTER
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City | CERRITOS
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State | CA
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Zip | 90703-2640
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Country | US
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Telephone | 562-402-0688
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Fax | 562-402-3032
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Provider Business Mailing Address
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Address Line | 17707 STUDEBAKER ROAD RIO HONDO MENTAL HEALTH CENTER
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-402-0688
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Fax | 562-402-3032
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 375813
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License Number State | CA
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