Provider Demographics
NPI:1376266064
Name:GRANIZO, LILIA MOJICA (RD)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:MOJICA
Last Name:GRANIZO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 MARATHON PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2856
Mailing Address - Country:US
Mailing Address - Phone:951-808-7334
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 105D
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-346-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered