Healthcare Provider Details

I. General information

NPI: 1679827778
Provider Name (Legal Business Name): PALECEK,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 H AVE
CORONADO CA
92118-1222
US

IV. Provider business mailing address

260 H AVE
CORONADO CA
92118-1222
US

V. Phone/Fax

Practice location:
  • Phone: 619-519-2554
  • Fax:
Mailing address:
  • Phone: 619-519-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7272
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY7272
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPST7272
License Number StateCA

VIII. Authorized Official

Name: DR. GLORY ANN PALECEK
Title or Position: PRESIDENT
Credential: PHD
Phone: 619-519-2554