Healthcare Provider Details

I. General information

NPI: 1336054907
Provider Name (Legal Business Name): NATALIA M MARTINEZ AGOSTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M15 CALLE 18
CAGUAS PR
00725-2452
US

IV. Provider business mailing address

M15 CALLE 18
CAGUAS PR
00725-2452
US

V. Phone/Fax

Practice location:
  • Phone: 787-402-0240
  • Fax:
Mailing address:
  • Phone: 787-402-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2312
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: