Provider Demographics
NPI:1477678241
Name:VITARO, NATHAN (NMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:VITARO
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14350 N. FRANK LLOYD WRIGHT BLVD.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-707-3535
Mailing Address - Fax:602-707-3536
Practice Address - Street 1:14350 N. FRANK LLOYD WRIGHT BLVD.
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:602-707-3535
Practice Address - Fax:602-707-3536
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03-731175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath