Provider Demographics
NPI:1326150392
Name:PALMER, MARK ANTON (MS, RD, CNIS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTON
Last Name:PALMER
Suffix:
Gender:M
Credentials:MS, RD, CNIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VA LOMA LINDA HEALTHCARE SYSTEM (120)
Mailing Address - Street 2:11201 BENTON STREET
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-0001
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-422-3108
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-422-3108
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered