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NPI Code Detail

MEDICARE: MRS. ALBA IRIS CARBONELL LND

MEDICARE: MRS. ALBA IRIS CARBONELL 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
1133NN1002XNutrition Education Nutritionist1235PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11235OTHERPRLND
21235OTHERPRCLE

General Provider Information

NPI Number : 1750564498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALBA IRIS CARBONELL LND
Provider Business Mailing Address
First Line : 110 CALLE PEDRO ARZUAGA E
Second Line : VILLAS DEL CENTRO APT. # 52
City : CAROLINA
State : PR
Zip : 00985-6167
Country : US
Telephone Number : 787-550-5362
Fax Number :
Provider Business Practice Location Address
First Line : 1715 AVE PONCE DE LEON
Second Line : NUTRITION DEPARTMENT
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 : 12/17/2007
Last Update Date : 12/17/2007

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Directions to “ MRS. ALBA IRIS CARBONELL LND” Practice Location

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