Provider Demographics
NPI:1790184596
Name:DINE MONTE NIDO, LLC
Entity Type:Organization
Organization Name:DINE MONTE NIDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RADANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-589-8999
Mailing Address - Street 1:27162 SEA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4437
Mailing Address - Country:US
Mailing Address - Phone:310-457-9958
Mailing Address - Fax:
Practice Address - Street 1:237 EAST LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333
Practice Address - Country:US
Practice Address - Phone:215-350-5526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty