Healthcare Provider Details

I. General information

NPI: 1982395117
Provider Name (Legal Business Name): LAVITA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 160.9 BO GUANAJIBO LOCAL 4
HORMIGUEROS PR
00660
US

IV. Provider business mailing address

182 SOUTH RAMON EMETERIO BETANCES
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-9090
  • Fax: 787-827-9595
Mailing address:
  • Phone: 787-827-9090
  • Fax: 787-827-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGGIE RODRIGUEZ
Title or Position: ADMINSTRATOR
Credential:
Phone: 939-271-4978