Provider Demographics
NPI:1285406546
Name:VILLARREAL, THOMAS ISAIAH (RD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ISAIAH
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 JENNIFER PL
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1031
Mailing Address - Country:US
Mailing Address - Phone:626-429-0022
Mailing Address - Fax:
Practice Address - Street 1:23420 SPECTRUM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3438
Practice Address - Country:US
Practice Address - Phone:626-429-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86297069133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered