Provider Demographics
NPI:1134528458
Name:PALMER, ROSSLYN MICHELLE (DDR TRANSPORTATION)
Entity type:Individual
Prefix:MRS
First Name:ROSSLYN
Middle Name:MICHELLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DDR TRANSPORTATION
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:KEITH
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDR TRANSPORTATION
Mailing Address - Street 1:2230 LAKE PARK DR SPC 168
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-7568
Mailing Address - Country:US
Mailing Address - Phone:951-487-2317
Mailing Address - Fax:
Practice Address - Street 1:2230 LAKE PARK DR SPC 168
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-7568
Practice Address - Country:US
Practice Address - Phone:951-487-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA039131347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle