Healthcare Provider Details

I. General information

NPI: 1467592725
Provider Name (Legal Business Name): MARITZA BONNET RD,LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND. DARLINGTON 1007 AVENIDA LUIS MUNOZ RIVERA SUITE 1201
SAN JUAN PR
00925-2726
US

IV. Provider business mailing address

COND. DARLINGTON 1007 AVENIDA LUIS MUNOZ RIVERA SUITE 1201
SAN JUAN PR
00925-2726
US

V. Phone/Fax

Practice location:
  • Phone: 939-273-2507
  • Fax:
Mailing address:
  • Phone: 939-273-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1407
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: