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General NPI Number Information
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NPI Number | 1265988422
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Entity Type | Individual
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Provider Name | MARIELA PALACIOS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 2999 E STEARNS ST
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City | BREA
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State | CA
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Zip | 92821-4745
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Country | US
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Telephone | 714-255-1346
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Fax |
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Provider Business Mailing Address
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Address Line | 150 S ALMA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90063-2411
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Country | US
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Telephone | 323-787-9403
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Fax |
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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 | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number |
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License Number State | CA
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