Healthcare Provider Details

I. General information

NPI: 1801597513
Provider Name (Legal Business Name): CALLA ELIZABETH VALIQUETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 08/08/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 300
PHOENIX AZ
85016-4879
US

IV. Provider business mailing address

31 E THOMAS RD APT 460
PHOENIX AZ
85012-0057
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-6211
  • Fax:
Mailing address:
  • Phone: 414-477-6345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: