Healthcare Provider Details

I. General information

NPI: 1942686142
Provider Name (Legal Business Name): DAVID PICELLA PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 MACKINAW CT
EASTVALE CA
91752-1492
US

IV. Provider business mailing address

836 N DEL SOL LN
DIAMOND BAR CA
91765-1105
US

V. Phone/Fax

Practice location:
  • Phone: 877-241-8200
  • Fax: 909-245-1751
Mailing address:
  • Phone: 877-241-8200
  • Fax: 909-245-1751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DAVID V PICELLA
Title or Position: PRESIDENT
Credential: PHD, NP
Phone: 877-241-8200