Provider Demographics
NPI:1598380388
Name:MUNGUIA, NATHAN BRIAN (RDN, LDN)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:BRIAN
Last Name:MUNGUIA
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 W TALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3706
Mailing Address - Country:US
Mailing Address - Phone:773-990-5563
Mailing Address - Fax:
Practice Address - Street 1:7345 W TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3706
Practice Address - Country:US
Practice Address - Phone:773-990-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered