MEDICARE: WELLNESS BY JENNY MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1164111720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS BY JENNY MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	R9 AVE LUIS MUNOZ MARIN
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-6461
Country	:	US
Telephone Number	:	787-961-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	R9 AVE LUIS MUNOZ MARIN
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-6461
Country	:	US
Telephone Number	:	787-961-5656
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER SUAREZ SERRANO
Credential	:	LND
Telephone Number	:	787-475-4933

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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