Provider Demographics
NPI:1689297806
Name:MUNOZ, JACQUELINE MERCEDES (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MERCEDES
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4308 MARCUS URIBE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3721
Mailing Address - Country:US
Mailing Address - Phone:915-383-1496
Mailing Address - Fax:
Practice Address - Street 1:4308 MARCUS URIBE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3721
Practice Address - Country:US
Practice Address - Phone:915-383-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7468133V00000X
1098019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered