Healthcare Provider Details

I. General information

NPI: 1790731461
Provider Name (Legal Business Name): MR. SANTO TROMBETTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE
GRAND JUNCTION CO
81501-6428
US

IV. Provider business mailing address

533 HERON CT
GRAND JUNCTION CO
81503-1403
US

V. Phone/Fax

Practice location:
  • Phone: 970-244-1314
  • Fax:
Mailing address:
  • Phone: 970-244-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: