Provider Demographics
NPI:1336778448
Name:DE TRANALTES, KAYLEE (MD)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:DE TRANALTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-4516
Mailing Address - Country:US
Mailing Address - Phone:602-257-4323
Mailing Address - Fax:
Practice Address - Street 1:1300 S 10TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-4516
Practice Address - Country:US
Practice Address - Phone:602-257-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine