Provider Demographics
NPI:1083024145
Name:VITANTONIO, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:VITANTONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90294-2277
Mailing Address - Country:US
Mailing Address - Phone:310-923-1437
Mailing Address - Fax:310-439-3701
Practice Address - Street 1:20331 IRVINE AVE STE E2
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0223
Practice Address - Country:US
Practice Address - Phone:949-228-9676
Practice Address - Fax:877-987-7729
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH208352084N0400X
TXT15932084N0400X
CAA1433442084N0400X, 2084N0600X
MI43015024492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology