Provider Demographics
NPI:1295381838
Name:HIRTES, GIAVONNA MARIA
Entity Type:Individual
Prefix:
First Name:GIAVONNA
Middle Name:MARIA
Last Name:HIRTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 STOCKTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-363-6655
Mailing Address - Fax:
Practice Address - Street 1:10 STOCKTON DRIVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-363-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2021-12-20
Deactivation Date:2019-10-16
Deactivation Code:
Reactivation Date:2021-12-16
Provider Licenses
StateLicense IDTaxonomies
NJ86027972133V00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered