Provider Demographics
NPI:1407198393
Name:PALMER, MARIA (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1399 ROXBURY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4709
Mailing Address - Country:US
Mailing Address - Phone:310-557-3759
Mailing Address - Fax:310-557-3450
Practice Address - Street 1:1399 ROXBURY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4709
Practice Address - Country:US
Practice Address - Phone:310-557-3759
Practice Address - Fax:310-557-3450
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11661363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical