Provider Demographics
NPI:1962666040
Name:VIGLIETTI, GINA C
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:C
Last Name:VIGLIETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:VIGLIETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:42 BOWIE BEND CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3573
Mailing Address - Country:US
Mailing Address - Phone:913-710-5348
Mailing Address - Fax:
Practice Address - Street 1:42 BOWIE BEND CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-3573
Practice Address - Country:US
Practice Address - Phone:913-710-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003004047133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered