Basic Information
| Provider Information | |||||||||
| NPI: | 1689105819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | THERESE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2975 SYCAMORE DR | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930651201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059556000 | ||||||||
| FaxNumber: | 8059556909 | ||||||||
| Practice Location | |||||||||
| Address1: | 2975 SYCAMORE DR | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930651201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059556000 | ||||||||
| FaxNumber: | 8059556909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 18485 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 09356739 | 05 | MS | MEDICAID |