Provider Demographics
NPI:1922027275
Name:PALLICCIA, EUGENE V (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:V
Last Name:PALLICCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25751 MCBEAN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3701
Mailing Address - Country:US
Mailing Address - Phone:661-284-3122
Mailing Address - Fax:
Practice Address - Street 1:25751 MCBEAN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3701
Practice Address - Country:US
Practice Address - Phone:661-284-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44916Medicare UPIN
CAWG31928IMedicare ID - Type Unspecified
CAWG31928HMedicare ID - Type Unspecified
CAWG31928LMedicare ID - Type Unspecified
CAWG31928KMedicare ID - Type Unspecified
CAWG31828JMedicare ID - Type Unspecified