Provider Demographics
NPI:1376382853
Name:VIGLIANO, DOUGLAS (MBA)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:VIGLIANO
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 GOLDEN GATE PARK
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732
Mailing Address - Country:US
Mailing Address - Phone:321-480-1393
Mailing Address - Fax:
Practice Address - Street 1:2601 GOLDEN GATE PARK
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732
Practice Address - Country:US
Practice Address - Phone:321-480-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist