Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 3338 | NV |
NPI | 1245527753 |
---|---|
Provider Name | Patrick J Colletti |
First Address | Reno, NV 89503-5512 |
Second Address | Reno, NV 89503-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 05/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016499 | (05) | NV |