Healthcare Provider Details

I. General information

NPI: 1265172910
Provider Name (Legal Business Name): LUISA MARIA HERNANDEZ BUSTO RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BLVD MEDIA LUNA APT 3803
CAROLINA PR
00987-5298
US

IV. Provider business mailing address

74 BLVD MEDIA LUNA 3803
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-579-7184
  • Fax:
Mailing address:
  • Phone: 787-579-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86114321
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: