Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 20A8171 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 20A8171 | CA |
NPI | 1205885951 |
---|---|
Provider Name | Dr. Damion Jay Valletta |
First Address | La Jolla, CA 92039-3533 |
Second Address | San Diego, CA 92111-5343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 30/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H28865 | (02) | CA |