Provider Demographics
NPI:1407369465
Name:DOLCE VITA NUTRITION
Entity Type:Organization
Organization Name:DOLCE VITA NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSCIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSP, LDN
Authorized Official - Phone:610-529-7966
Mailing Address - Street 1:208 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5025
Mailing Address - Country:US
Mailing Address - Phone:610-529-7966
Mailing Address - Fax:
Practice Address - Street 1:14 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2607
Practice Address - Country:US
Practice Address - Phone:610-529-7966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030490710001Medicaid