Provider Demographics
NPI:1790005999
Name:PALILIS, DIMITRIOS MICHAEL (AUD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:MICHAEL
Last Name:PALILIS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 EMPIRE ST # 210
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5562
Mailing Address - Country:US
Mailing Address - Phone:707-759-4419
Mailing Address - Fax:510-483-3685
Practice Address - Street 1:744 EMPIRE ST # 210
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5562
Practice Address - Country:US
Practice Address - Phone:707-759-4419
Practice Address - Fax:510-483-3685
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2496231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist