Healthcare Provider Details

I. General information

NPI: 1932696754
Provider Name (Legal Business Name): CHRISTINE CAMILLE PALMA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DR. MICHAEL DEBAKEY DR. CREDENTIALING
LAKE CHARLES LA
70601
US

IV. Provider business mailing address

501 DR. MICHAEL DEBAKEY DR. CREDENTIALING
LAKE CHARLES LA
70601
US

V. Phone/Fax

Practice location:
  • Phone: 337-312-8120
  • Fax: 337-312-8121
Mailing address:
  • Phone: 337-312-8528
  • Fax: 337-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number326818
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: