Individual
MISTI D PALMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
9047 ARROW RTE, RANCHO CUCAMONGA, CA 91730-4449
(909) 466-8696
Mailing address
11305 BELLEGRAVE AVE, MIRA LOMA, CA 91752-1602
(909) 263-9716
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 35030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 35030
BOARD OF VOCATIONAL NURSES AND PSYCHIATRIC TECHNICIANS
CA
Enumeration date
01/20/2011
Last updated
01/20/2011
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