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General NPI Number Information
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NPI Number | 1790296085
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Entity Type | Individual
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Provider Name | MYLEEN PALASIO SIMONE NMD
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Gender | Female
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 14961 W BELL RD STE A125
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City | SURPRISE
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State | AZ
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Zip | 85374-3200
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Country | US
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Telephone | 623-252-1390
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Fax | 602-581-7142
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Provider Business Mailing Address
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Address Line | 18273 W MAUNA LOA LN
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City | SURPRISE
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State | AZ
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Zip | 85388-7637
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Country | US
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Telephone | 626-807-3917
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 17-1648
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License Number State | AZ
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