MEDICARE: RAFAEL PALACIOS ABOC

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
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1629773114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL PALACIOS ABOC

Provider Business Mailing Address
First Line	:	1403 KERRICK ST
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2224
Country	:	US
Telephone Number	:	323-493-4468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 W AVENUE K STE 203C
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-5925
Country	:	US
Telephone Number	:	661-522-0610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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