Provider Demographics
NPI:1689712358
Name:PALISADES PEDIATRICS
Entity type:Organization
Organization Name:PALISADES PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:310-454-4466
Mailing Address - Street 1:910 VIA DE LA PAZ
Mailing Address - Street 2:SUITE #207
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3515
Mailing Address - Country:US
Mailing Address - Phone:310-454-4466
Mailing Address - Fax:310-454-0916
Practice Address - Street 1:910 VIA DE LA PAZ
Practice Address - Street 2:SUITE #207
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3515
Practice Address - Country:US
Practice Address - Phone:310-454-4466
Practice Address - Fax:310-454-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG070850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty