Healthcare Provider Details

I. General information

NPI: 1548727654
Provider Name (Legal Business Name): MARICELY NIEVES VELEZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AVE DR SUSONI
HATILLO PR
00659-1847
US

IV. Provider business mailing address

89 CALLE PEDRO HERNANDEZ
QUEBRADILLAS PR
00678-1915
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-4190
  • Fax: 787-262-3984
Mailing address:
  • Phone: 787-364-0741
  • Fax: 787-262-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2033
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: