Provider Demographics
NPI:1477056398
Name:PALACIOS, DAYANA
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 IMPERIAL STREET SUITE 6
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:442-258-5508
Mailing Address - Fax:
Practice Address - Street 1:725 W STATE STREET APT 42
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9224
Practice Address - Country:US
Practice Address - Phone:442-258-5508
Practice Address - Fax:442-258-5508
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician