MEDICARE: LUCY 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1659853398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY PALACIOS

Provider Business Mailing Address
First Line	:	9911 TWEEDY LN
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90240-3809
Country	:	US
Telephone Number	:	702-695-8414
Fax Number	:

Provider Business Practice Location Address
First Line	:	10210 ORR AND DAY RD
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3581
Country	:	US
Telephone Number	:	562-348-0113
Fax Number	:	562-348-0089

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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Directions to “ LUCY PALACIOS ” Practice Location

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