Provider Demographics
NPI:1881897965
Name:SMITH, CARMEN PALACIO (RD)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:PALACIO
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 N RANCHO VISTOSO BLVD
Mailing Address - Street 2:STE. 150
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1840
Mailing Address - Country:US
Mailing Address - Phone:520-870-7717
Mailing Address - Fax:520-469-7807
Practice Address - Street 1:1601 N. TUCSON BLVD
Practice Address - Street 2:STE. 5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-325-3540
Practice Address - Fax:520-325-8259
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
721599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered