Basic Information
| Provider Information | |||||||||
| NPI: | 1821379306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALKO | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | FRANCISCA | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316785500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956719529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169852561 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2011 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY25803 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.