Provider Demographics
NPI:1508953134
Name:PALMAN, BRENT R (PA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:R
Last Name:PALMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CORPORATE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2107
Mailing Address - Country:US
Mailing Address - Phone:949-388-8022
Mailing Address - Fax:949-388-8033
Practice Address - Street 1:1300 AVENIDA VISTA HERMOSA
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6315
Practice Address - Country:US
Practice Address - Phone:949-489-4290
Practice Address - Fax:949-489-4293
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16774363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00127807OtherRAILROAD MEDICARE
CAWPA16774FMedicare PIN
CAWPA16774DMedicare PIN
CAAT464ZMedicare PIN
CAWPA16774BMedicare PIN
CAWPA16774GMedicare PIN
CAWPA16774CMedicare PIN
CAWPA16774KMedicare PIN
CAAT464UMedicare PIN
CAWPA16774AMedicare PIN
CAWPA16774HMedicare PIN
CAAT464VMedicare PIN
CAAT464WMedicare PIN
CAAT464YMedicare PIN
CAAT646TMedicare PIN
CAWPA16774EMedicare PIN
CAP00127807OtherRAILROAD MEDICARE
CAP39016Medicare UPIN
CAAT464SMedicare PIN