Provider Demographics
NPI:1801464607
Name:PALACIO, SALVADOR R
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:R
Last Name:PALACIO
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 1:13847 JICARILLA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5832
Mailing Address - Country:US
Mailing Address - Phone:951-287-2200
Mailing Address - Fax:
Practice Address - Street 1:13090 SUNDOWN RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8873
Practice Address - Country:US
Practice Address - Phone:951-287-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician