Provider Demographics
NPI:1053084954
Name:PALACIOS, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6587 RANCHO DEL SOL WAY APT 17
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5682
Mailing Address - Country:US
Mailing Address - Phone:760-562-4506
Mailing Address - Fax:
Practice Address - Street 1:2810 LONG BEACH BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1558
Practice Address - Country:US
Practice Address - Phone:562-933-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS