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1083024145

NPI Code Detail

MEDICARE: DR. DANIEL VITANTONIO MD

MEDICARE: DR. DANIEL VITANTONIO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	20835	NH
2	2084N0400X	Neurology Physician	A143344	CA
3	2084N0400X	Neurology Physician	4301502449	MI
4	2084N0600X	Clinical Neurophysiology Physician	A143344	CA
5	2084N0400X	Neurology Physician	T1593	TX

General Provider Information

NPI Number	:	1083024145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL VITANTONIO MD

Provider Business Mailing Address
First Line	:	PO BOX 2277
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90294-2277
Country	:	US
Telephone Number	:	310-923-1437
Fax Number	:	310-439-3701

Provider Business Practice Location Address
First Line	:	475 WASHINGTON BLVD
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5287
Country	:	US
Telephone Number	:	310-923-1437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	03/24/2026

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Directions to “ DR. DANIEL VITANTONIO MD” Practice Location

Language	Start Address	Practice Location

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