Healthcare Provider Details

I. General information

NPI: 1912822537
Provider Name (Legal Business Name): VITALIA NUTRICION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA AGUSTIN RAMOS CALERO INTERIOR CARR 112 KM 1.4
ISABELA PR
00622-4245
US

IV. Provider business mailing address

PO BOX 378
SAN SEBASTIAN PR
00685-0378
US

V. Phone/Fax

Practice location:
  • Phone: 939-366-3652
  • Fax:
Mailing address:
  • Phone: 939-366-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: NORELYS MARIE LOPEZ ACEVEDO
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-964-5173