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General NPI Number Information
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NPI Number | 1083024145
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Entity Type | Individual
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Provider Name | DANIEL VITANTONIO MD
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Gender | Male
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 20331 IRVINE AVE STE E2
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0223
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Country | US
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Telephone | 949-228-9676
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Fax | 877-987-7729
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Provider Business Mailing Address
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Address Line | PO BOX 2277
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City | VENICE
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State | CA
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Zip | 90294-2277
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Country | US
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Telephone | 310-923-1437
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Fax | 310-439-3701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 20835
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | T1593
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A143344
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301502449
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | A143344
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License Number State | CA
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