MEDICARE: MR. SHAWN LEE THURSBY-PALMER NP

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
1	207Q00000X	Family Medicine Physician	2023030	CA

General Provider Information

NPI Number	:	1780321562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN LEE THURSBY-PALMER NP

Provider Business Mailing Address
First Line	:	21166 PLACERITA CANYON RD
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-1923
Country	:	US
Telephone Number	:	951-775-4413
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 W TEMPLE ST STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4529
Country	:	US
Telephone Number	:	951-775-4413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	05/13/2022

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