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

Table of content: (NPI 1336237080)

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".




Copyright © 2007-2025 www.npivalidator.com