Active NPI
Mianie Palacios
- Community Health Worker
- Los Angeles, CA
National Provider Identifier
1811763931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 8939 S Sepulveda Blvd Ste 460
Los Angeles, CA 90045-3653 - Phone
- (310) 337-7417
- Fax
- (310) 337-7413
- NPI assigned
- Nov 29, 2023
- Reactivated
- May 16, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CA | Primary | |
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
8939 S Sepulveda Blvd Ste 460
Los Angeles, CA 90045-3653
Mailing address
8939 S Sepulveda Blvd Ste 460
Los Angeles, CA 90045-3653
Phone (310) 337-7417
Other practice location 1
100 S Anaheim Blvd Ste 340
Anaheim, CA 92805-3877
Phone (888) 428-3223
Other practice location 2
2569 W Woodland Dr
Anaheim, CA 92801-2608
Phone (888) 428-3223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717027200000",
"number": "1811763931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8939 S SEPULVEDA BLVD STE 460",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900453653",
"telephone_number": "310-337-7417",
"fax_number": "310-337-7413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8939 S SEPULVEDA BLVD STE 460",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900453653",
"telephone_number": "310-337-7417",
"fax_number": "310-337-7413"
}
],
"practiceLocations": [
{
"address_1": "100 S Anaheim Blvd Ste 340",
"address_purpose": "LOCATION",
"city": "Anaheim",
"state": "CA",
"postal_code": "928053877",
"country_code": "US",
"telephone_number": "888-428-3223",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2569 W Woodland Dr",
"address_purpose": "LOCATION",
"city": "Anaheim",
"state": "CA",
"postal_code": "928012608",
"country_code": "US",
"telephone_number": "888-428-3223",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PALACIOS",
"first_name": "MIANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-29",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"deactivation_date": "2024-04-30",
"reactivation_date": "2024-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.