Basic Information
Provider Information | |||||||||
NPI: | 1699168914 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VILLANO | ||||||||
FirstName: | DANIELLE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FOLTZ | ||||||||
OtherFirstName: | DANIELLE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.S. R.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3533 S ALAMEDA ST | ||||||||
Address2: | 5TH FLOOR SLOAN BLDG | ||||||||
City: | CORPUS CHRISTI | ||||||||
State: | TX | ||||||||
PostalCode: | 784111721 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3616946128 | ||||||||
FaxNumber: | 3616946955 | ||||||||
Practice Location | |||||||||
Address1: | 3533 S ALAMEDA ST | ||||||||
Address2: | 5TH FLOOR SLOAN BLDG | ||||||||
City: | CORPUS CHRISTI | ||||||||
State: | TX | ||||||||
PostalCode: | 784111721 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3616946128 | ||||||||
FaxNumber: | 3616946955 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/11/2015 | ||||||||
LastUpdateDate: | 03/11/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT83662 | TX | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.