Healthcare Provider Details

I. General information

NPI: 1922592724
Provider Name (Legal Business Name): PALOMA VELETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

4002 W WETHERSFIELD RD
PHOENIX AZ
85029-2986
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-625-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN150573
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218701
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: