1336237080 NPI number — SCHUBERT PALMER, M.D., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336237080 NPI number — SCHUBERT PALMER, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHUBERT PALMER, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336237080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 331100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-224-2040
Provider Business Mailing Address Fax Number:
323-224-2061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 E CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-2464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-224-2040
Provider Business Practice Location Address Fax Number:
323-224-2061
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMER
Authorized Official First Name:
HIRAM
Authorized Official Middle Name:
SCHUBERT
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
323-224-2040

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CN2872 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0100070 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FNP 24978 . This is a "MED. BOARD FICTITIOUS NAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ66380Z . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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