Healthcare Provider Details

I. General information

NPI: 1801707039
Provider Name (Legal Business Name): CHRISTIAN ALEXANDER MUNOZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CEDAR PATH
LINCOLN RI
02865-4803
US

IV. Provider business mailing address

3 CEDAR PATH
LINCOLN RI
02865-4803
US

V. Phone/Fax

Practice location:
  • Phone: 915-319-9047
  • Fax:
Mailing address:
  • Phone: 915-319-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86288940
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: