Provider Demographics
NPI:1629773114
Name:PALACIOS, RAFAEL (ABOC)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 KERRICK ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2224
Mailing Address - Country:US
Mailing Address - Phone:323-493-4468
Mailing Address - Fax:
Practice Address - Street 1:1805 W AVENUE K STE 203C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5925
Practice Address - Country:US
Practice Address - Phone:661-522-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician