MEDICARE: CRYSTAL MARIE VILA R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1689959991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MARIE VILA R.D.

Provider Business Mailing Address
First Line	:	2807 S FAIRVIEW ST UNIT E
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5917
Country	:	US
Telephone Number	:	909-472-5145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 S FAIRVIEW ST UNIT E
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5917
Country	:	US
Telephone Number	:	909-472-5145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/17/2025

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