Provider Demographics
NPI:1184925802
Name:DIDATO, VINCENZO (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MR
First Name:VINCENZO
Middle Name:
Last Name:DIDATO
Suffix:
Gender:M
Credentials:REGISTERED DIETITIAN
Other - Prefix:MR
Other - First Name:VINCE
Other - Middle Name:
Other - Last Name:DIDATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9824 QUANDT AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1353
Mailing Address - Country:US
Mailing Address - Phone:734-658-4699
Mailing Address - Fax:
Practice Address - Street 1:9824 QUANDT AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1353
Practice Address - Country:US
Practice Address - Phone:734-658-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1058708133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered