Provider Demographics
NPI:1629546130
Name:JOSH VELLA, M.D., PLLC
Entity type:Organization
Organization Name:JOSH VELLA, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-512-8558
Mailing Address - Street 1:3200 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2326
Mailing Address - Country:US
Mailing Address - Phone:602-393-4263
Mailing Address - Fax:602-393-2329
Practice Address - Street 1:3200 E CAMELBACK RD STE 180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2326
Practice Address - Country:US
Practice Address - Phone:602-393-4263
Practice Address - Fax:602-393-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203476Medicaid