Provider Demographics
NPI:1912160177
Name:PABLO P. PRIETTO, M.D. INC
Entity Type:Organization
Organization Name:PABLO P. PRIETTO, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRIETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-522-2001
Mailing Address - Street 1:1892 PARK SKYLINE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3120
Mailing Address - Country:US
Mailing Address - Phone:714-458-2894
Mailing Address - Fax:714-838-4680
Practice Address - Street 1:805 W LA VETA AVE STE 104
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3928
Practice Address - Country:US
Practice Address - Phone:714-550-0070
Practice Address - Fax:714-550-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7821207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G78210Medicaid
CAA58032Medicare UPIN
CAW15801Medicare PIN