Provider Demographics
NPI:1679827778
Name:PALECEK,INC.
Entity Type:Organization
Organization Name:PALECEK,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PALECEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-519-2554
Mailing Address - Street 1:260 H AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1222
Mailing Address - Country:US
Mailing Address - Phone:619-519-2554
Mailing Address - Fax:
Practice Address - Street 1:260 H AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1222
Practice Address - Country:US
Practice Address - Phone:619-519-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7272103TC0700X, 103TC2200X
CAPST7272103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508193491OtherTRICARE