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General NPI Number Information
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NPI Number | 1003242447
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Entity Type | Individual
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Provider Name | JOSEPH ANDREW VITAGLIANO PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 1110 E MISSOURI AVE STE 110
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City | PHOENIX
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State | AZ
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Zip | 85014-2703
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Country | US
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Telephone | 480-542-8202
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Fax |
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Provider Business Mailing Address
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Address Line | 4279 E TETHER TRL
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City | PHOENIX
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State | AZ
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Zip | 85050-8949
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Country | US
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Telephone | 480-212-6408
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5483
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5483
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License Number State | AZ
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