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General NPI Number Information
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NPI Number | 1265566061
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Entity Type | Individual
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Provider Name | VANESSA TARTAGLIA-KEANE D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 18275 N 59TH AVE BLDG K SUITE 162
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City | GLENDALE
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State | AZ
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Zip | 85308-1254
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Country | US
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Telephone | 602-547-8184
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Fax | 602-547-8339
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Provider Business Mailing Address
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Address Line | 18275 N 59TH AVE BLDG K SUITE 162
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City | GLENDALE
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State | AZ
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Zip | 85308-1254
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Country | US
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Telephone | 602-547-8184
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Fax | 602-547-8339
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 7057360001
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4426
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License Number State | AZ
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