Provider Demographics
NPI:1952696957
Name:BELLETTO, JANNA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:LYNN
Last Name:BELLETTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3745
Mailing Address - Country:US
Mailing Address - Phone:209-825-5155
Mailing Address - Fax:209-825-6155
Practice Address - Street 1:1040 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3745
Practice Address - Country:US
Practice Address - Phone:209-825-5155
Practice Address - Fax:209-825-6155
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant