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NPI Code Detail

MEDICARE: MS. MILDRED HERNANDEZ DIETICIAN

MEDICARE:  MS. MILDRED  HERNANDEZ  DIETICIAN
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
1132700000XDietary Manager645PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1645OTHERPRDIETICIAN'S LICENSE

General Provider Information

NPI Number : 1659492932
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MILDRED HERNANDEZ DIETICIAN
Provider Business Mailing Address
First Line : 1471 CALLE HUMACAO
Second Line : STOP 20
City : SAN JUAN
State : PR
Zip : 00909-2633
Country : US
Telephone Number : 787-722-4564
Fax Number : 787-771-7951
Provider Business Practice Location Address
First Line : 1715 AVE PONCE DE LEON
Second Line : NUTRITION DEPT.
City : SAN JUAN
State : PR
Zip : 00909-1958
Country : US
Telephone Number : 787-758-2000
Fax Number : 787-771-7951
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/08/2007

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Directions to “ MS. MILDRED HERNANDEZ DIETICIAN” Practice Location

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