Provider Demographics
NPI:1104029776
Name:PALETZ, DAVI L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVI
Middle Name:L
Last Name:PALETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVI
Other - Middle Name:LIANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:FOREST FALLS
Mailing Address - State:CA
Mailing Address - Zip Code:92339-0625
Mailing Address - Country:US
Mailing Address - Phone:520-360-4611
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST RM A108
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:520-360-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101562207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine