Healthcare Provider Details

I. General information

NPI: 1336601962
Provider Name (Legal Business Name): JOHN JOSEPH CORLETTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NORTH LOOP ROAD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

390 NORTH LOOP
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5950
  • Fax:
Mailing address:
  • Phone: 760-383-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA180047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: