Provider Demographics
NPI:1376595579
Name:SILVA-PALACIOS, VICTOR (PHD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:SILVA-PALACIOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93443-0756
Mailing Address - Country:US
Mailing Address - Phone:805-801-7590
Mailing Address - Fax:805-528-1266
Practice Address - Street 1:3220 S HIGUERA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6987
Practice Address - Country:US
Practice Address - Phone:805-801-7590
Practice Address - Fax:805-528-1266
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL141980Medicare ID - Type Unspecified