Healthcare Provider Details

I. General information

NPI: 1598134470
Provider Name (Legal Business Name): GLORIA D FIDALGO CORDOVA PHD, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CALLE SIERRA NEVADA MIRADERO HILLS
MAYAGUEZ PR
00682-7806
US

IV. Provider business mailing address

PO BOX 3182
MAYAGUEZ PR
00681-3182
US

V. Phone/Fax

Practice location:
  • Phone: 787-806-6310
  • Fax:
Mailing address:
  • Phone: 787-806-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number846
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number846
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: