Provider Demographics
NPI:1962882829
Name:MUNOZ, CRISTINA (LND)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB 323
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-396-1916
Mailing Address - Fax:
Practice Address - Street 1:1300 CALLE ATENAS
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7807
Practice Address - Country:US
Practice Address - Phone:787-396-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1457Medicaid