Healthcare Provider Details

I. General information

NPI: 1154296655
Provider Name (Legal Business Name): GIORINES PENA - CRUZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 CALLE INGENIO HACIENDA MARGARITA
LUQUILLO PR
00773-3031
US

IV. Provider business mailing address

272 CALLE INGENIO HACIENDA MARGARITA
LUQUILLO PR
00773-3031
US

V. Phone/Fax

Practice location:
  • Phone: 787-435-9615
  • Fax:
Mailing address:
  • Phone: 787-435-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2151
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: