Most Relevant Information
Provider Data
| NPI Number: | 1003396177 |
| Provider Name: | DWIGHT MARSHALL TAN VILLANUEVA RRT |
| Entity Type: | Individual |
| Taxonomy Code: | 227900000X |
| Specialty: | Respiratory Therapist, Registered |
| License Number: | 25583 |
Most Important Dates
| Enumeration Date: | 08/17/2018 |
| Last Updated: | 12/01/2021 |
Provider Practice Location
3440 E LA PALMA AVE
ANAHEIM
CA
928062020
Practice Location Phone/Fax
| Phone: | 7146442000 |
| Fax: |
Provider Mailing Location
18518 BETTY WAY
CERRITOS
CA
907036320
Provider Mailing Phone/Fax
| Phone: | 7146844257 |
| Fax: |