Provider Demographics
NPI:1063989523
Name:PALIWODA, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:PALIWODA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4415
Mailing Address - Country:US
Mailing Address - Phone:818-437-6865
Mailing Address - Fax:
Practice Address - Street 1:1555 N VERDUGO RD STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-3207
Practice Address - Country:US
Practice Address - Phone:833-968-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst