Provider Demographics
NPI:1568643534
Name:PALACIOS, IRENE (RN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14180 BEACH BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4452
Mailing Address - Country:US
Mailing Address - Phone:714-896-7851
Mailing Address - Fax:714-896-7808
Practice Address - Street 1:14180 BEACH BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4452
Practice Address - Country:US
Practice Address - Phone:714-896-7851
Practice Address - Fax:714-896-7808
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN556124163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health