Healthcare Provider Details

I. General information

NPI: 1669656526
Provider Name (Legal Business Name): JOSEPH A ROTELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4555
US

IV. Provider business mailing address

10117 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4555
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-5808
  • Fax: 480-614-5809
Mailing address:
  • Phone: 480-614-5808
  • Fax: 480-614-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number40913
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: