Provider Demographics
NPI:1639474299
Name:DITTRICH, MATTHEW (CPO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:DITTRICH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6685 ENCHANTED VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1758
Mailing Address - Country:US
Mailing Address - Phone:775-225-5618
Mailing Address - Fax:775-787-8179
Practice Address - Street 1:6685 ENCHANTED VALLEY DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-1758
Practice Address - Country:US
Practice Address - Phone:775-225-5618
Practice Address - Fax:775-787-8179
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist