Provider Demographics
NPI:1023551926
Name:DEL MATTO, LORELLE (MS, RDN, CD)
Entity Type:Individual
Prefix:MS
First Name:LORELLE
Middle Name:
Last Name:DEL MATTO
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E LAKE SAMMAMISH SHORE LN NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6923
Mailing Address - Country:US
Mailing Address - Phone:206-228-0792
Mailing Address - Fax:
Practice Address - Street 1:161 E LAKE SAMMAMISH SHORE LN NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-6923
Practice Address - Country:US
Practice Address - Phone:206-228-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60321762133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered