MEDICARE: ERICA ILIANA 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	171M00000X	Case Manager/Care Coordinator
2	373H00000X	Day Training/Habilitation Specialist
3	172V00000X	Community Health Worker
4	101YM0800X	Mental Health Counselor	96910	CA
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1801970637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ILIANA PALACIOS

Provider Business Mailing Address
First Line	:	PO BOX 32075
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-0075
Country	:	US
Telephone Number	:	323-388-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 MAGNOLIA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-2909
Country	:	US
Telephone Number	:	213-269-2233
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/01/2025

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