Provider Demographics
NPI:1497751457
Name:PALLIA, CHRIS S (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:S
Last Name:PALLIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:S
Other - Last Name:PALLIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:230 PROSPECT PL
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1978
Mailing Address - Country:US
Mailing Address - Phone:619-435-7282
Mailing Address - Fax:619-435-3723
Practice Address - Street 1:230 PROSPECT PL
Practice Address - Street 2:STE 230
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1976
Practice Address - Country:US
Practice Address - Phone:619-435-7282
Practice Address - Fax:619-435-3723
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74481207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H5089Medicare UPIN
CAWA74481CMedicare PIN