Provider Demographics
NPI:1609540814
Name:VILLA, CAROLINA (MDS, RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINA
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:MDS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 BRAIDS DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8928
Mailing Address - Country:US
Mailing Address - Phone:956-898-6895
Mailing Address - Fax:
Practice Address - Street 1:7811 MCPHERSON RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2802
Practice Address - Country:US
Practice Address - Phone:956-712-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85754133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered