1174653141 NPI number — MR. J. JAVIER PALACIOS L-SA

Table of content: MR. J. JAVIER PALACIOS L-SA (NPI 1174653141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174653141 NPI number — MR. J. JAVIER PALACIOS L-SA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALACIOS
Provider First Name:
J.
Provider Middle Name:
JAVIER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L-SA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174653141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78766-9205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-467-0989
Provider Business Mailing Address Fax Number:
512-323-9703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 W SAINT JOHNS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78757-2241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-467-0989
Provider Business Practice Location Address Fax Number:
512-323-9703
Provider Enumeration Date:
03/07/2007

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: 208600000X , with the licence number:  SA00280 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0032LF . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com