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General NPI Number Information
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NPI Number | 1972079515
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Entity Type | Individual
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Provider Name | MIRANDA VILLAREAL LD
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Gender | Female
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 5203 JUAN TABO BLVD NE STE 2A
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2691
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Country | US
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Telephone | 505-266-6121
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 JUAN TABO BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2681
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Country | US
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Telephone |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD-1228
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License Number State | NM
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