1124147145 NPI number — MARIA ESPERANZA PALACIOS M.D.

Table of content: MARIA ESPERANZA PALACIOS M.D. (NPI 1124147145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124147145 NPI number — MARIA ESPERANZA PALACIOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALACIOS
Provider First Name:
MARIA
Provider Middle Name:
ESPERANZA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOKADDEM
Provider Other First Name:
MARIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124147145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7151 CASCADE VALLEY CT
Provider Second Line Business Mailing Address:
# 105
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-565-4917
Provider Business Mailing Address Fax Number:
702-562-8680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7151 CASCADE VALLEY CT
Provider Second Line Business Practice Location Address:
# 105
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-565-4917
Provider Business Practice Location Address Fax Number:
702-562-8680
Provider Enumeration Date:
03/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  11785 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)