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NPI Code Detail

MEDICARE: MR. DAVID JOHN PALMER LCSW

MEDICARE: MR. DAVID JOHN PALMER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS20198CA

General Provider Information

NPI Number : 1053489567
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID JOHN PALMER LCSW
Provider Business Mailing Address
First Line : 1907 BOYS REPUBLIC DRIVE
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709
Country : US
Telephone Number : 909-628-1217
Fax Number : 909-993-1106
Provider Business Practice Location Address
First Line : 1907 BOYS REPUBLIC DR
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5447
Country : US
Telephone Number : 909-628-1217
Fax Number : 909-993-1106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 07/21/2022

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