Healthcare Provider Details

I. General information

NPI: 1104343342
Provider Name (Legal Business Name): ALANA MINNEE MARRERO GONZALEZ LND MHSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CALLE HEAVENLY VW
GURABO PR
00778-9725
US

IV. Provider business mailing address

371 CALLE JOSE DE DIEGO
RIO PIEDRAS PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-371-5624
  • Fax:
Mailing address:
  • Phone: 787-767-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1516
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: