Provider Demographics
NPI:1891726469
Name:MOLITOR, DIANE (MA,RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MOLITOR
Suffix:
Gender:F
Credentials:MA,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 BAYOU VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2092
Mailing Address - Country:US
Mailing Address - Phone:813-681-6607
Mailing Address - Fax:
Practice Address - Street 1:859 BAYOU VIEW DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2092
Practice Address - Country:US
Practice Address - Phone:813-681-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 842133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND 842OtherDIETITIAN