Provider Demographics
NPI:1770689671
Name:MATTALINO, ANGELO JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:JAMES
Last Name:MATTALINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8580 E SHEA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6684
Mailing Address - Country:US
Mailing Address - Phone:480-763-5950
Mailing Address - Fax:480-763-1375
Practice Address - Street 1:8580 E SHEA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6684
Practice Address - Country:US
Practice Address - Phone:480-763-5950
Practice Address - Fax:480-763-1375
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17728207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ26072Medicare PIN
AZB63798Medicare UPIN