Provider Demographics
NPI:1801597513
Name:VALIQUETTE, CALLA ELIZABETH
Entity type:Individual
Prefix:
First Name:CALLA
Middle Name:ELIZABETH
Last Name:VALIQUETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E THOMAS RD APT 460
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-0057
Mailing Address - Country:US
Mailing Address - Phone:414-477-6345
Mailing Address - Fax:
Practice Address - Street 1:2222 E HIGHLAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4879
Practice Address - Country:US
Practice Address - Phone:602-277-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant