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NPI Code Detail

MEDICARE: KRYSTAL PALACIOS

MEDICARE: KRYSTAL PALACIOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1518430586
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL PALACIOS
Provider Business Mailing Address
First Line : 20 N DEWITT AVE
Second Line :
City : CLOVIS
State : CA
Zip : 93612-0311
Country : US
Telephone Number : 559-575-8172
Fax Number :
Provider Business Practice Location Address
First Line : 11150 W OLYMPIC BLVD STE 1160
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1826
Country : US
Telephone Number : 424-559-5300
Fax Number : 818-671-2774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2019
Last Update Date : 05/12/2022

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Directions to “ KRYSTAL PALACIOS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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