MEDICARE: DIANA VITTORIO RD

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	133V00000X	Registered Dietitian	ND7425	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JA395Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265952493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA VITTORIO RD

Provider Business Mailing Address
First Line	:	1575 PINE RIDGE RD STE 19
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2110
Country	:	US
Telephone Number	:	239-593-0663
Fax Number	:	239-593-0664

Provider Business Practice Location Address
First Line	:	1575 PINE RIDGE RD STE 19
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2110
Country	:	US
Telephone Number	:	239-593-0663
Fax Number	:	239-593-0664

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	07/20/2020

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Directions to “ DIANA VITTORIO RD” Practice Location

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