MEDICARE: IDAMIS ALBANDOZ LND

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	1147	PR

General Provider Information

NPI Number	:	1427126358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDAMIS ALBANDOZ LND

Provider Business Mailing Address
First Line	:	URB RIO GRANDE ESTATES CALLE31 FF 40
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-5058
Country	:	US
Telephone Number	:	787-309-1147
Fax Number	:	787-888-7388

Provider Business Practice Location Address
First Line	:	AVE MONSERRATE AA 3
Second Line	:	VALLE ARRIBA HEIGHT
City	:	CAROLINA
State	:	PR
Zip	:	00985-5444
Country	:	US
Telephone Number	:	787-776-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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