Provider Demographics
NPI:1801991955
Name:PALMARES, DANTHEA MAE (RPT)
Entity type:Individual
Prefix:PROF
First Name:DANTHEA
Middle Name:MAE
Last Name:PALMARES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14827 GERMAIN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2112
Mailing Address - Country:US
Mailing Address - Phone:818-363-3000
Mailing Address - Fax:818-363-3099
Practice Address - Street 1:10515 BALBOA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6350
Practice Address - Country:US
Practice Address - Phone:818-363-3000
Practice Address - Fax:818-363-3099
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28812208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation