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General NPI Number Information
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NPI Number | 1942686142
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Entity Type | Organization
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Legal Business Name | DAVID PICELLA PHD INC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 7121 MACKINAW CT
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City | EASTVALE
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State | CA
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Zip | 91752-1492
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Country | US
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Telephone | 877-241-8200
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Fax | 909-245-1751
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Provider Business Mailing Address
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Address Line | 836 N DEL SOL LN
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1105
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Country | US
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Telephone | 877-241-8200
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Fax | 909-245-1751
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID V PICELLA
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Credential | PHD, NP
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Telephone | 877-241-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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