Provider Demographics
NPI:1881020543
Name:MONROE, CAROL MAE (RD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MAE
Last Name:MONROE
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 1:2825 J ST STE 435A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-978-0300
Mailing Address - Fax:916-978-0333
Practice Address - Street 1:2825 J ST STE 435A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-978-0300
Practice Address - Fax:916-978-0333
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered