Provider Demographics
NPI:1710643275
Name:MUNOZ, CARLOS ROJAS (RDN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ROJAS
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32293 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1770
Mailing Address - Country:US
Mailing Address - Phone:951-534-8605
Mailing Address - Fax:
Practice Address - Street 1:4210 RIVERWALK PKWY STE 400
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3313
Practice Address - Country:US
Practice Address - Phone:951-534-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86055789133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered