Healthcare Provider Details

I. General information

NPI: 1427106095
Provider Name (Legal Business Name): A. REENU PALIWAL MD MBA MPH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N ORANGE GROVE AVE SUITE 206
POMONA CA
91767-3028
US

IV. Provider business mailing address

109 CORNELL AVE
CLAREMONT CA
91711-4602
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-2300
  • Fax: 909-469-2472
Mailing address:
  • Phone: 909-235-6770
  • Fax: 888-273-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA95984
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA95984
License Number StateCA

VIII. Authorized Official

Name: DR. AMIT REENU PALIWAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-235-6770