Provider Demographics
NPI:1780321562
Name:THURSBY-PALMER, SHAWN LEE (NP)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:LEE
Last Name:THURSBY-PALMER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21166 PLACERITA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1923
Mailing Address - Country:US
Mailing Address - Phone:951-775-4413
Mailing Address - Fax:
Practice Address - Street 1:3030 W TEMPLE ST STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4529
Practice Address - Country:US
Practice Address - Phone:951-775-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine