Provider Demographics
NPI:1356603690
Name:PALAU, VICTORIA (TEACHER)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PALAU
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14420 VILLAGE RD
Mailing Address - Street 2:65GA
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-6329
Mailing Address - Country:US
Mailing Address - Phone:347-993-2726
Mailing Address - Fax:
Practice Address - Street 1:14420 VILLAGE RD
Practice Address - Street 2:65GA
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-6329
Practice Address - Country:US
Practice Address - Phone:347-993-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY17440000X SPECIALIST174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist