Healthcare Provider Details

I. General information

NPI: 1134228828
Provider Name (Legal Business Name): HIRAM SCHUBERT PALMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SCHUBERT PALMER M.D.

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 331100
LOS ANGELES CA
90033-0002
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 TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG45372
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG45372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: