Provider Demographics
NPI:1790772549
Name:ANGELETTI, MICHAEL (MS RD CSCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ANGELETTI
Suffix:
Gender:M
Credentials:MS RD CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 BIGGS AVE
Mailing Address - Street 2:37 AMDS/SGPZ
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-671-7481
Mailing Address - Fax:210-447-9547
Practice Address - Street 1:2513 BIGGS AVE
Practice Address - Street 2:37 AMDS/SGPZ
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-671-7481
Practice Address - Fax:210-447-9547
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered