Provider Demographics
NPI:1861885568
Name:PALO, LOGAN RAYMOND (MHRS)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:RAYMOND
Last Name:PALO
Suffix:
Gender:M
Credentials:MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 MCKEE RD BLDG C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1406
Mailing Address - Country:US
Mailing Address - Phone:408-926-7996
Mailing Address - Fax:
Practice Address - Street 1:1993 MCKEE RD
Practice Address - Street 2:BLDG. C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1406
Practice Address - Country:US
Practice Address - Phone:408-926-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator