Healthcare Provider Details

I. General information

NPI: 1700790821
Provider Name (Legal Business Name): ANGELA DAWN PALMER BCHN,NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 NOYES ST APT 304
SAN DIEGO CA
92109-3642
US

IV. Provider business mailing address

4730 NOYES ST APT 304
SAN DIEGO CA
92109-3642
US

V. Phone/Fax

Practice location:
  • Phone: 619-807-1387
  • Fax:
Mailing address:
  • Phone: 619-807-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberB2022007578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: