Provider Demographics
NPI:1326066697
Name:VALLETTA, STEPHEN (CCP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:VALLETTA
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27588
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7588
Mailing Address - Country:US
Mailing Address - Phone:480-777-0607
Mailing Address - Fax:480-777-1345
Practice Address - Street 1:8121 N 18TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3965
Practice Address - Country:US
Practice Address - Phone:602-513-9568
Practice Address - Fax:480-777-1345
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ901224Medicaid