Healthcare Provider Details

I. General information

NPI: 1528211505
Provider Name (Legal Business Name): LAURA CARDOVA LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C39 URB. ENRAMADA CALL CAMINO DE NARDOS
BAYAMON PR
00961
US

IV. Provider business mailing address

C39 URB. ENRAMADA CALL CAMINO DE NARDOS
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-756-8907
Mailing address:
  • Phone: 787-777-3535
  • Fax: 787-756-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number782
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: