Healthcare Provider Details

I. General information

NPI: 1912160177
Provider Name (Legal Business Name): PABLO P. PRIETTO, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA AVE STE 104
ORANGE CA
92868-3928
US

IV. Provider business mailing address

1892 PARK SKYLINE RD
SANTA ANA CA
92705-3120
US

V. Phone/Fax

Practice location:
  • Phone: 714-550-0070
  • Fax: 714-550-0035
Mailing address:
  • Phone: 714-458-2894
  • Fax: 714-838-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG7821
License Number StateCA

VIII. Authorized Official

Name: PABLO P PRIETTO
Title or Position: OWNER
Credential: M.D
Phone: 714-522-2001