MEDICARE: DALLANTE COLVIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	D07833809	AZ

General Provider Information

NPI Number	:	1730043746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLANTE COLVIN

Provider Business Mailing Address
First Line	:	7850 W MCDOWELL RD APT 1077
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-4276
Country	:	US
Telephone Number	:	623-238-0583
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 W MCDOWELL RD APT 1077
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-4276
Country	:	US
Telephone Number	:	623-238-0583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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Directions to “ DALLANTE COLVIN ” Practice Location

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