Provider Demographics
NPI:1821569062
Name:VENDITUOLI, TRACY ROMAINE
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ROMAINE
Last Name:VENDITUOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0631
Mailing Address - Country:US
Mailing Address - Phone:520-732-9371
Mailing Address - Fax:
Practice Address - Street 1:19 LA MONTANA CORTE
Practice Address - Street 2:
Practice Address - City:SONOITA
Practice Address - State:AZ
Practice Address - Zip Code:85637
Practice Address - Country:US
Practice Address - Phone:520-732-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6810224ZL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision