Healthcare Provider Details

I. General information

NPI: 1285024018
Provider Name (Legal Business Name): ME NUTRITION SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMINO ALEJANDRINO C-6 VILLA CLEMENTINA
GUAYNABO PR
00969
US

IV. Provider business mailing address

2 CALLE HORTENSIA APT 12-G
SAN JUAN PR
00926-6439
US

V. Phone/Fax

Practice location:
  • Phone: 787-402-7304
  • Fax:
Mailing address:
  • Phone: 787-402-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1492
License Number StatePR

VIII. Authorized Official

Name: MARIA EUGENIA RODRIGUEZ
Title or Position: DIETITIAN
Credential: MS, RD, CSR, LND
Phone: 787-402-7304