Provider Demographics
NPI:1194306811
Name:VILLALON, SABRINA SUZAINNE (RDN)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:SUZAINNE
Last Name:VILLALON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:SUZAINNE
Other - Last Name:BOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3025 CASHION PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3712 E 11TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-3952
Practice Address - Country:US
Practice Address - Phone:918-834-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK133V00000X
OK2583133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered