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General NPI Number Information
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NPI Number | 1407369465
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Entity Type | Organization
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Legal Business Name | DOLCE VITA NUTRITION
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 14 THOMAS AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-2607
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Country | US
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Telephone | 610-529-7966
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Fax |
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Provider Business Mailing Address
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Address Line | 208 BROOKWOOD DR
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City | AMBLER
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State | PA
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Zip | 19002-5025
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Country | US
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Telephone | 610-529-7966
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Fax |
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Authorized Official
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Title or Position | DIETITIAN/OWNER
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Name | KRISTEN ROSCIOLI
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Credential | RD, CSP, LDN
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Telephone | 610-529-7966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN003698
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License Number State | PA
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