Doctor Name: | MR. STACY TALAHYTEWA |
NPI Number: | 1871818492 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RT(R) |
License Number: | CRT-10799 |
Business Practice Address: | Hwy 264 Mile Post 388 Polacca, AZ - 86042 |
Business Phone Number: | 9287376210 |
Business Fax Number: | |
Mailing Address: | Po Box 1019, POLACCA |
State: | AZ |
Postal Code: | 860421019 |
Phone Number: | 9287349450 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2010 |
NPI Last Update Date: | 04/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 247100000X |
License Number: | CRT-10799 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |