Provider Demographics
NPI:1245366517
Name:RACZ, DIANE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:RACZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MAPLE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2229
Mailing Address - Country:US
Mailing Address - Phone:330-792-2594
Mailing Address - Fax:
Practice Address - Street 1:175 MAPLE LEAF DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2229
Practice Address - Country:US
Practice Address - Phone:330-792-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered