Healthcare Provider Details

I. General information

NPI: 1447591383
Provider Name (Legal Business Name): CHRISTINE A PATORNITI RD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10586 PARKINGTON LN UNIT 38A
HIGHLANDS RANCH CO
80126-6756
US

IV. Provider business mailing address

7760 E PEAKVIEW AVE
CENTENNIAL CO
80111-6885
US

V. Phone/Fax

Practice location:
  • Phone: 201-647-0907
  • Fax:
Mailing address:
  • Phone: 201-647-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1064421
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: