Provider Demographics
NPI:1073164331
Name:VILLA GAMINO, CRISTINA TERESA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:TERESA
Last Name:VILLA GAMINO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 BRIAR ROCK RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3528
Mailing Address - Country:US
Mailing Address - Phone:281-363-1005
Mailing Address - Fax:844-817-2685
Practice Address - Street 1:318 BRIAR ROCK RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3528
Practice Address - Country:US
Practice Address - Phone:281-363-1005
Practice Address - Fax:844-817-2685
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered