Provider Demographics
NPI:1265909451
Name:HINOJOSA, CHANEL VILLANUEVA (RD)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:VILLANUEVA
Last Name:HINOJOSA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:ALICIA
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4886 MAUREEN LN
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-7126
Mailing Address - Country:US
Mailing Address - Phone:805-630-1632
Mailing Address - Fax:
Practice Address - Street 1:400 MOBIL AVE STE D9
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6376
Practice Address - Country:US
Practice Address - Phone:805-444-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1054059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered