Healthcare Provider Details

I. General information

NPI: 1558741140
Provider Name (Legal Business Name): HEALTHY HABITS BY GR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-165 CENTRO INTERNACIONAL DE MERCADEO TORRE 1 OFICINA 401
GUAYNABO PR
00968
US

IV. Provider business mailing address

PR-165 CENTRO INTERNACIONAL DE MERCADEO TORRE 1 OFICINA 401
GUAYNABO PR
00968
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-0600
  • Fax:
Mailing address:
  • Phone: 787-667-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1891
License Number StatePR

VIII. Authorized Official

Name: MS. GETSENI RODRIGUEZ JIMENEZ
Title or Position: NUTRICIONISTA DIETISTA
Credential:
Phone: 787-409-0115