Provider Demographics
NPI:1851993638
Name:VILLICANA CORIA, SOPHIA (BS, RD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:VILLICANA CORIA
Suffix:
Gender:F
Credentials:BS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLEROCK
Mailing Address - State:CA
Mailing Address - Zip Code:93543-3004
Mailing Address - Country:US
Mailing Address - Phone:661-839-2011
Mailing Address - Fax:
Practice Address - Street 1:7303 PEACHTREE LN
Practice Address - Street 2:
Practice Address - City:LITTLEROCK
Practice Address - State:CA
Practice Address - Zip Code:93543-3004
Practice Address - Country:US
Practice Address - Phone:661-839-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86172676133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered