Healthcare Provider Details

I. General information

NPI: 1467328534
Provider Name (Legal Business Name): NUTRICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CALLE EL YAGRUMO
JUANA DIAZ PR
00795-2814
US

IV. Provider business mailing address

122 CALLE EL YAGRUMO
JUANA DIAZ PR
00795-2814
US

V. Phone/Fax

Practice location:
  • Phone: 787-484-0203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANGELICA M VELEZ BOBE
Title or Position: OWNER
Credential: RDN, LND
Phone: 787-484-0203