Provider Demographics
NPI:1760170203
Name:PALCON, NELSON LLACUNA JR (LVN)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:LLACUNA
Last Name:PALCON
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37814 VERANDA WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4776
Mailing Address - Country:US
Mailing Address - Phone:760-539-2488
Mailing Address - Fax:
Practice Address - Street 1:37814 VERANDA WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4776
Practice Address - Country:US
Practice Address - Phone:760-539-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706611164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse