Organization
CHRISTINE I DIMAIO
Active
Organization
CHRISTINE I DIMAIO
Active
Other names
Irenes Fitting Room
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE I DIMAIO (OWNER)
(707) 303-7261
Entity
Organization
Contact information
Practice address
5979 COMMERCE BLVD STE 10, ROHNERT PARK, CA 94928-1650
(707) 303-7261
Mailing address
5979 COMMERCE BLVD STE 10, ROHNERT PARK, CA 94928-1650
(707) 303-7261
(860) 747-9500
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
—
224P00000X
Prosthetist
CMF01542
CT
Other
Enumeration date
11/10/2010
Last updated
11/12/2019
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