Healthcare Provider Details

I. General information

NPI: 1003242447
Provider Name (Legal Business Name): JOSEPH ANDREW VITAGLIANO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E MISSOURI AVE STE 110
PHOENIX AZ
85014-2703
US

IV. Provider business mailing address

4279 E TETHER TRL
PHOENIX AZ
85050-8949
US

V. Phone/Fax

Practice location:
  • Phone: 480-542-8202
  • Fax:
Mailing address:
  • Phone: 480-212-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5483
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5483
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: