Healthcare Provider Details

I. General information

NPI: 1376989798
Provider Name (Legal Business Name): MYRNA BERRIOS NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B5 CALLE TABONUCO STE 211 GALERIA SAN PATRICIO
GUAYNABO PR
00968-3013
US

IV. Provider business mailing address

B5 TABONUCO STREET GALERIA SAN PATRICIO SUITE 211
GUAYNABO PR
00968
US

V. Phone/Fax

Practice location:
  • Phone: 787-522-0540
  • Fax: 787-522-0541
Mailing address:
  • Phone: 787-522-0540
  • Fax: 787-522-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number629
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: