MEDICARE: MS. MARTHA RUBIDIA PALACIOS MSW

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	104100000X	Social Worker	18579	CA

General Provider Information

NPI Number	:	1902007479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA RUBIDIA PALACIOS MSW

Provider Business Mailing Address
First Line	:	409 W 102ND ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-4403
Country	:	US
Telephone Number	:	213-590-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 E 118TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-2518
Country	:	US
Telephone Number	:	323-249-2950
Fax Number	:	323-249-2980

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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