Healthcare Provider Details

I. General information

NPI: 1649589979
Provider Name (Legal Business Name): LOURDES Y MUNIZ BADILLO LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EL NUEVO PR CONCRA BRUMBAUGH 1162
RIO PIEDRAS PR
00926
US

IV. Provider business mailing address

CONDOMINIO BOSQUE DEL RIO BUZON 54, APTO H102
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-9463
  • Fax:
Mailing address:
  • Phone: 787-379-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1485
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: