Basic Information
| Provider Information | |||||||||
| NPI: | 1346840782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELATORE | ||||||||
| FirstName: | LILLIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 338 LONSDALE AVE | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454193248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372718115 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | OH | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | LD.08873 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.