Basic Information
Provider Information | |||||||||
NPI: | 1588956783 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCALZITTI | ||||||||
FirstName: | HEIDI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BETETA | ||||||||
OtherFirstName: | HEIDI | ||||||||
OtherMiddleName: | PATRICIA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7270 | ||||||||
Address2: |   | ||||||||
City: | MORENO VALLEY | ||||||||
State: | CA | ||||||||
PostalCode: | 925527270 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9514865700 | ||||||||
FaxNumber: | 9514865705 | ||||||||
Practice Location | |||||||||
Address1: | 26520 CACTUS AVE | ||||||||
Address2: |   | ||||||||
City: | MORENO VALLEY | ||||||||
State: | CA | ||||||||
PostalCode: | 925553927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9514865700 | ||||||||
FaxNumber: | 9514865705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2011 | ||||||||
LastUpdateDate: | 10/30/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A124990 | CA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | A124990 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.