Healthcare Provider Details

I. General information

NPI: 1063841799
Provider Name (Legal Business Name): JOSE CRUZ-PADILLA LND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANSIONES DEL CARIBE CALLE ZAFIRO AB-45
HUMACAO PR
00791-5205
US

IV. Provider business mailing address

MANSIONES DEL CARIBE 108 CALLE ZAFIRO AB 45
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-455-9385
  • Fax:
Mailing address:
  • Phone: 787-454-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1665
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: