Basic Information
| Provider Information | |||||||||
| NPI: | 1205940228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELETTO | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1312 PRENTICE DR | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954483381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074333383 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1312 PRENTICE DR | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954483381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074333383 | ||||||||
| FaxNumber: | 7074337210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G58852 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.