Healthcare Provider Details

I. General information

NPI: 1245416320
Provider Name (Legal Business Name): SCHUBERT PALMER, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 WHITTIER BLVD
LOS ANGELES CA
90023-2526
US

IV. Provider business mailing address

1701 E CESAR E CHAVEZ AVE SUITE 403
LOS ANGELES CA
90033-2464
US

V. Phone/Fax

Practice location:
  • Phone: 323-224-2040
  • Fax: 323-224-2061
Mailing address:
  • Phone: 323-224-2040
  • Fax: 323-224-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG45372
License Number StateCA

VIII. Authorized Official

Name: MS. MARINA RAMIREZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 323-224-2040