Healthcare Provider Details

I. General information

NPI: 1649371600
Provider Name (Legal Business Name): COLLETTI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4797 CAUGHLIN PKWY STE 110
RENO NV
89519-1013
US

IV. Provider business mailing address

4797 CAUGHLIN PKWY STE 110
RENO NV
89519-1013
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-1880
  • Fax: 775-322-1897
Mailing address:
  • Phone: 775-322-1880
  • Fax: 775-322-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANNI M GOODRICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 775-322-1880