Healthcare Provider Details

I. General information

NPI: 1326066697
Provider Name (Legal Business Name): STEPHEN VALLETTA C.C.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 N 18TH WAY
PHOENIX AZ
85020-3965
US

IV. Provider business mailing address

PO BOX 27588
TEMPE AZ
85285-7588
US

V. Phone/Fax

Practice location:
  • Phone: 602-513-9568
  • Fax: 480-777-1345
Mailing address:
  • Phone: 480-777-0607
  • Fax: 480-777-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: