Provider Demographics
NPI:1326695032
Name:PALMER, BROOKE A
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92344-0660
Mailing Address - Country:US
Mailing Address - Phone:760-810-5107
Mailing Address - Fax:
Practice Address - Street 1:10720 CEDAR ST
Practice Address - Street 2:
Practice Address - City:OAK HILLS
Practice Address - State:CA
Practice Address - Zip Code:92344-0660
Practice Address - Country:US
Practice Address - Phone:760-815-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician