Healthcare Provider Details

I. General information

NPI: 1679596720
Provider Name (Legal Business Name): JOSH C VELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E CAMELBACK RD STE 180
PHOENIX AZ
85018-2326
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 180
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-4263
  • Fax: 602-393-2329
Mailing address:
  • Phone: 602-393-4263
  • Fax: 602-393-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01061712A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36777
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: