Provider Demographics
NPI:1578599981
Name:DAMION J VALLETTA DO PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAMION J VALLETTA DO PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAMION
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-524-7000
Mailing Address - Street 1:PO BOX 13533
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92039-3533
Mailing Address - Country:US
Mailing Address - Phone:858-524-7000
Mailing Address - Fax:858-524-7005
Practice Address - Street 1:7625 MESA COLLEGE DR STE 320A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-524-7000
Practice Address - Fax:858-524-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8171207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH28865Medicare UPIN
CA5698370001Medicare NSC
CAW19973Medicare PIN