Healthcare Provider Details

I. General information

NPI: 1023212255
Provider Name (Legal Business Name): MIREYDA BAEZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLAS DE SAN AGUSTIN AVE SAN AGUSTIN D21
BAYAMON PR
00959-2040
US

IV. Provider business mailing address

URB VILLAS DE SAN AGUSTIN AVE SAN AGUSTIN D21
BAYAMON PR
00959-2040
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-1929
  • Fax:
Mailing address:
  • Phone: 787-409-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1339
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: