Provider Demographics
NPI:1023359767
Name:MALOUIN, MATTHEW A (RD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:MALOUIN
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 1:6349 SAN DIEGO AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3136
Mailing Address - Country:US
Mailing Address - Phone:909-658-9371
Mailing Address - Fax:
Practice Address - Street 1:6349 SAN DIEGO AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3136
Practice Address - Country:US
Practice Address - Phone:909-658-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered