Healthcare Provider Details

I. General information

NPI: 1679617047
Provider Name (Legal Business Name): DIANE RUTH HOPP RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

IV. Provider business mailing address

4826 LOCKWOOD RD
PERRY OH
44081-9722
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-2262
  • Fax: 440-997-6360
Mailing address:
  • Phone: 440-259-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD. 824
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: