Provider Demographics
NPI:1073093704
Name:PALACIOS, CRYSTAL DENISE (LVN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DENISE
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 HUECO SANDS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5247
Mailing Address - Country:US
Mailing Address - Phone:915-730-0154
Mailing Address - Fax:
Practice Address - Street 1:221 N KANSAS ST STE 744
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1443
Practice Address - Country:US
Practice Address - Phone:915-213-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338183164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952346876OtherHOME HEALTH