Provider Demographics
NPI:1548426380
Name:PICELLA, DAVID (PHD, FNP, GS-C, CPG)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:PICELLA
Suffix:
Gender:M
Credentials:PHD, FNP, GS-C, CPG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S LEMON AVE
Mailing Address - Street 2:1295
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2706
Mailing Address - Country:US
Mailing Address - Phone:877-241-8200
Mailing Address - Fax:909-245-1751
Practice Address - Street 1:836 N DEL SOL LN
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1105
Practice Address - Country:US
Practice Address - Phone:877-241-8200
Practice Address - Fax:909-245-1751
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10299363LG0600X, 363LF0000X
CACNS269364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist