Provider Demographics
NPI:1952894636
Name:VILLANUEVA, ANJELICA NICOLE (RD)
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:NICOLE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HARRIER WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4155
Mailing Address - Country:US
Mailing Address - Phone:956-279-8288
Mailing Address - Fax:
Practice Address - Street 1:3714 COFFEE RD STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5002
Practice Address - Country:US
Practice Address - Phone:956-279-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86032738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty