Healthcare Provider Details

I. General information

NPI: 1366601809
Provider Name (Legal Business Name): MENNONITE DIABETES FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOMINGO TORRES BLDG SUITE 306
CAYEY PR
00737
US

IV. Provider business mailing address

PO BOX 373130
CAYEY PR
00737-3130
US

V. Phone/Fax

Practice location:
  • Phone: 787-535-1001
  • Fax: 787-535-1059
Mailing address:
  • Phone: 787-535-1001
  • Fax: 787-535-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. MIRIAM AIXA QUINONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-535-1001