Provider Demographics
NPI:1659068872
Name:VILLANUEVA, KIEL DOMINIC A
Entity Type:Individual
Prefix:MR
First Name:KIEL DOMINIC
Middle Name:A
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8039 160TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1107
Mailing Address - Country:US
Mailing Address - Phone:347-210-3874
Mailing Address - Fax:
Practice Address - Street 1:8039 160TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1107
Practice Address - Country:US
Practice Address - Phone:347-210-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist