Individual
MR. STACY TALAHYTEWA II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT(R)
Contact information
Practice address
HWY 264 MILE POST 388, POLACCA, AZ 86042
(928) 737-6210
Mailing address
PO BOX 1019, POLACCA, AZ 86042-1019
(928) 734-9450
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
CRT-10799
AZ
Other
Enumeration date
04/07/2010
Last updated
04/07/2010
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