Provider Demographics
NPI:1639259054
Name:PALACIOS, QUISQUEYA (MD)
Entity Type:Individual
Prefix:
First Name:QUISQUEYA
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2400
Mailing Address - Country:US
Mailing Address - Phone:713-798-6918
Mailing Address - Fax:713-798-6374
Practice Address - Street 1:1709 DRYDEN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2400
Practice Address - Country:US
Practice Address - Phone:713-798-6918
Practice Address - Fax:713-798-6374
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9177207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125454201Medicaid
TX88H421Medicare PIN
E35099Medicare UPIN
TX125454201Medicaid