Provider Demographics
NPI:1093723611
Name:HARVEY F PALITZ MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HARVEY F PALITZ MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-575-5882
Mailing Address - Street 1:1524 MCHENRY AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4568
Mailing Address - Country:US
Mailing Address - Phone:209-575-5885
Mailing Address - Fax:209-529-5471
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-575-5885
Practice Address - Fax:209-529-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26307207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G263070Medicaid
CAG26307OtherMD LICENSE
CAZZZ27840ZMedicare PIN
CA00G263070Medicaid