Provider Demographics
NPI:1508173816
Name:VITTITO, RENWICKE TROY SR
Entity Type:Individual
Prefix:MR
First Name:RENWICKE
Middle Name:TROY
Last Name:VITTITO
Suffix:SR
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 1:7200 BANCROFT AVE
Mailing Address - Street 2:SUITE 269
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2403
Mailing Address - Country:US
Mailing Address - Phone:510-746-1706
Mailing Address - Fax:510-746-1701
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:SUITE 269
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-746-1706
Practice Address - Fax:510-746-1701
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker