MEDICARE: DR. JOELLE MARIE COLETTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A55001	CA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A55001	CA

General Provider Information

NPI Number	:	1447222377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOELLE MARIE COLETTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:	858-249-6749
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W. ARBOR DR.
Second Line	:	MC 8892
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-7777
Fax Number	:	619-543-2652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2006
Last Update Date	:	09/06/2017

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