Provider Demographics
NPI:1942888391
Name:MENEXAS, KARYN (RDN)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:MENEXAS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-9767
Mailing Address - Country:US
Mailing Address - Phone:917-579-0751
Mailing Address - Fax:
Practice Address - Street 1:60 SCENIC DR
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CA
Practice Address - Zip Code:95570-9767
Practice Address - Country:US
Practice Address - Phone:917-579-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA916646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered