Healthcare Provider Details

I. General information

NPI: 1659292902
Provider Name (Legal Business Name): DENNIS ANDERSON-VILLALUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NEW SUDBURY ST 21ST FLOOR - 2126E
BOSTON MA
02203-0002
US

IV. Provider business mailing address

15 NEW SUDBURY ST. 21ST FLOOR - 2126.E
BOSTON MA
02203
US

V. Phone/Fax

Practice location:
  • Phone: 202-260-7333
  • Fax:
Mailing address:
  • Phone: 202-260-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN2824
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number993509
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: