Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY20670 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20670 | CA |
NPI | 1003088618 |
---|---|
Provider Name | Geneva Marie Palmer |
First Address | Represa, CA 95671-3000 |
Second Address | Represa, CA 95671-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2008 |
Last Update Date | 24/03/2008 |