Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013049857 |
---|---|
Provider Name | Diane Palacios |
First Address | Valley Village, CA 91607-2097 |
Second Address | Van Nuys, CA 91411-3119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |