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General NPI Number Information
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NPI Number | 1003396177
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Entity Type | Individual
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Provider Name | DWIGHT MARSHALL TAN VILLANUEVA RRT
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Gender | Male
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 3440 E LA PALMA AVE
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City | ANAHEIM
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State | CA
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Zip | 92806-2020
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Country | US
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Telephone | 714-644-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 18518 BETTY WAY
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City | CERRITOS
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State | CA
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Zip | 90703-6320
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Country | US
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Telephone | 714-684-4257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | 25583
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License Number State | CA
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