Provider Demographics
NPI:1396306254
Name:PALACIOS, FRANCO A
Entity type:Individual
Prefix:
First Name:FRANCO
Middle Name:A
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ATCHISON ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1212
Mailing Address - Country:US
Mailing Address - Phone:626-319-6003
Mailing Address - Fax:
Practice Address - Street 1:619 ATCHISON ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1212
Practice Address - Country:US
Practice Address - Phone:626-319-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99305622GOtherMADICAL