Provider Demographics
NPI:1942933916
Name:FERNANDO PALACIOS, MD, INC
Entity Type:Organization
Organization Name:FERNANDO PALACIOS, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-945-9345
Mailing Address - Street 1:201 BACKUS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4646
Mailing Address - Country:US
Mailing Address - Phone:323-945-9345
Mailing Address - Fax:
Practice Address - Street 1:201 BACKUS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4646
Practice Address - Country:US
Practice Address - Phone:323-945-9345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty