Provider Demographics
NPI:1649487901
Name:PALMER, ALLYN (LMT)
Entity type:Individual
Prefix:MRS
First Name:ALLYN
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 COPPER PENNY DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1828
Mailing Address - Country:US
Mailing Address - Phone:619-701-2990
Mailing Address - Fax:
Practice Address - Street 1:1764 SAN DIEGO AVENUE
Practice Address - Street 2:STE. 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-701-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist