Provider Demographics
NPI:1114389244
Name:VITTO, ANDRIUS
Entity Type:Individual
Prefix:
First Name:ANDRIUS
Middle Name:
Last Name:VITTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 JENNIFER ANN ST
Mailing Address - Street 2:APT 30
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-5052
Mailing Address - Country:US
Mailing Address - Phone:337-356-6350
Mailing Address - Fax:
Practice Address - Street 1:606 JENNIFER ANN ST
Practice Address - Street 2:APT 30
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-5052
Practice Address - Country:US
Practice Address - Phone:337-356-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007238658343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA81-1884918Other81-1884918