Derricketa Palacio

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

5715 S Broadway
Los Angeles, CA 90037-4131

Phone

(323) 948-0444

NPI assigned

Oct 22, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern California Alcohol & Drug Programs, Inc.

  • Children's Substance Abuse Rehabilitation Facility
  • Bellflower, CA
  • NPI 1538258777
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1043853039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5715 S BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900374131",
            "telephone_number": "323-948-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5715 S BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900374131",
            "telephone_number": "323-948-0444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16314 Cornuta Ave",
            "address_purpose": "LOCATION",
            "city": "Bellflower",
            "state": "CA",
            "postal_code": "907064814",
            "country_code": "US",
            "telephone_number": "562-923-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALACIO",
        "first_name": "DERRICKETA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-22",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melody Pakravan
• Naghmeh Paktan, D.O.
• Arvin Pal, DDS
• Liliana Palacino
• Amara Palacio
• Gilbert B. Palacio, LCSW
• Henry Palacio Jr.
• Jessica Elaine Palacio, MSW
• Mariel Palacio
• Sharon Palacio

• Addiction (Substance Use Disorder) Counselor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.