Healthcare Provider Details

I. General information

NPI: 1124965330
Provider Name (Legal Business Name): NUTRICLINICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ACOSTA ESQUINA CELIS TURABO MEDICAL PRIMARY GROUP
CAGUAS PR
00725
US

IV. Provider business mailing address

URB ALTAPAZ APT 72
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-566-2696
  • Fax:
Mailing address:
  • Phone: 787-566-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: STEFANY HERNANDEZ
Title or Position: CEO
Credential: LND
Phone: 787-566-2696