MEDICARE: A. REENU PALIWAL MD MBA MPH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	A95984	CA
2	207Q00000X	Family Medicine Physician	A95984	CA

General Provider Information

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

Provider Business Mailing Address
First Line	:	109 CORNELL AVE
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4602
Country	:	US
Telephone Number	:	909-235-6770
Fax Number	:	888-273-7369

Provider Business Practice Location Address
First Line	:	1818 N ORANGE GROVE AVE
Second Line	:	SUITE 206
City	:	POMONA
State	:	CA
Zip	:	91767-3028
Country	:	US
Telephone Number	:	909-623-2300
Fax Number	:	909-469-2472

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMIT REENU PALIWAL
Credential	:	M.D.
Telephone Number	:	909-235-6770

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/09/2014

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