Provider Demographics
NPI:1871475780
Name:AVILA, BRUCE (RD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 AMERICAN RIVER DR APT 109
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7024
Mailing Address - Country:US
Mailing Address - Phone:805-931-1525
Mailing Address - Fax:
Practice Address - Street 1:2348 AMERICAN RIVER DR APT 109
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7024
Practice Address - Country:US
Practice Address - Phone:805-931-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86331266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered