Provider Demographics
NPI:1154632362
Name:RITTENBERRY, SHELLA (IDMT)
Entity Type:Individual
Prefix:
First Name:SHELLA
Middle Name:
Last Name:RITTENBERRY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N L ST APT 141
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3354
Mailing Address - Country:US
Mailing Address - Phone:832-231-0090
Mailing Address - Fax:
Practice Address - Street 1:1300 N L ST APT 141
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3354
Practice Address - Country:US
Practice Address - Phone:832-231-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians