Healthcare Provider Details

I. General information

NPI: 1669625364
Provider Name (Legal Business Name): JOYCE VERDEJO LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UU22 CALLE YUNQUESITO MANSIONES DE CAROLINA
CAROLINA PR
00987-8125
US

IV. Provider business mailing address

UU22 CALLE YUNQUESITO MANSIONES DE CAROLINA
CAROLINA PR
00987-8125
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 Number1319
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: