Healthcare Provider Details

I. General information

NPI: 1396390506
Provider Name (Legal Business Name): VINCE RANALLI MASTER DPP TRAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 BAUM BLVD # 306
PITTSBURGH PA
15206-3793
US

IV. Provider business mailing address

5750 BAUM BLVD STE 306
PITTSBURGH PA
15206-3793
US

V. Phone/Fax

Practice location:
  • Phone: 412-593-2048
  • Fax: 844-311-7396
Mailing address:
  • Phone: 412-593-2048
  • Fax: 844-311-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: