Healthcare Provider Details

I. General information

NPI: 1053611723
Provider Name (Legal Business Name): GLENDALIS FIGUEROA LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SANTA TERESITA SANTA LUCIA STREET #4803
PONCE PR
00730-4529
US

IV. Provider business mailing address

URB. SANTA TERESITA #4803 SANTA LUCIA
PONCE PR
00730-4529
US

V. Phone/Fax

Practice location:
  • Phone: 787-486-8930
  • Fax: 787-844-7515
Mailing address:
  • Phone: 787-486-8930
  • Fax: 787-844-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1477
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: