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General NPI Number Information
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NPI Number | 1417233156
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Entity Type | Individual
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Provider Name | RENEE A MATGOURANIS LD/RD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 3435 TROY RD
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City | SPRINGFIELD
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State | OH
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Zip | 45504-4335
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Country | US
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Telephone | 937-342-8800
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Fax | 937-342-8805
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Provider Business Mailing Address
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Address Line | 31737 LEEWARD CT
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City | AVON LAKE
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State | OH
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Zip | 44012-2926
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Country | US
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Telephone | 440-933-2234
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2296
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License Number State | OH
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