Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1900 | OR |
NPI | 1124371836 |
---|---|
Provider Name | Dr. David Alfonso Palacios |
First Address | Portland, OR 97219-8954 |
Second Address | Lake Oswego, OR 97035-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 04/09/2020 |