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General NPI Number Information
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NPI Number | 1619030970
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Entity Type | Individual
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Provider Name | GLENN PALMBAUM PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 724 5TH ST
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City | MARYSVILLE
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State | CA
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Zip | 95901-5646
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Country | US
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Telephone | 530-743-7413
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Fax | 530-743-7971
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Provider Business Mailing Address
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Address Line | 530 WALNUT ST
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City | WOODLAND
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State | CA
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Zip | 95695-3936
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Country | US
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Telephone | 530-301-5780
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Fax | 530-743-7971
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA15585
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15585
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License Number State | CA
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