Provider Demographics
NPI:1689057960
Name:DAVID PICELLA PHD INC
Entity Type:Organization
Organization Name:DAVID PICELLA PHD INC
Other - Org Name:OMEGA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PICELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NP
Authorized Official - Phone:877-241-8200
Mailing Address - Street 1:836 N DEL SOL LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1105
Mailing Address - Country:US
Mailing Address - Phone:877-241-8200
Mailing Address - Fax:909-245-1751
Practice Address - Street 1:1617 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:877-241-8200
Practice Address - Fax:909-245-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CA10299363L00000X
CA269364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty