Healthcare Provider Details

I. General information

NPI: 1558099374
Provider Name (Legal Business Name): NICOLLE LORRAINE ROSADO HERNANDEZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND. ALTURAS DE MAYAGUEZ 325 AVE ALGARROBO APT 8H
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

COND. ALTURAS DE MAYAGUEZ 325 AVE ALGARROBO APT 8H
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-612-4015
  • Fax:
Mailing address:
  • Phone: 787-612-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2199
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86071737
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: