Provider Demographics
NPI:1790881159
Name:PALIWAL, AMIT REENU (MD MBA MPH)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:REENU
Last Name:PALIWAL
Suffix:
Gender:M
Credentials:MD MBA MPH
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:REENU
Other - Last Name:PALIWAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MBA MPH
Mailing Address - Street 1:2740 N GAREY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1800
Mailing Address - Country:US
Mailing Address - Phone:909-623-2300
Mailing Address - Fax:909-469-2472
Practice Address - Street 1:2740 N GAREY AVE STE 100
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1800
Practice Address - Country:US
Practice Address - Phone:909-623-2300
Practice Address - Fax:909-469-2472
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA959842083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A959840Medicaid
I67930Medicare UPIN