Healthcare Provider Details

I. General information

NPI: 1982819652
Provider Name (Legal Business Name): PRACTICA INTRAMURAL DE NUTRICION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GALINDE ST OFFICE G-12 NUTRITION CLINIC - EPS
SAN JUAN PR
00935
US

IV. Provider business mailing address

GALINDE ST OFFICE G-12 NUTRITION CLINIC - EPS
SAN JUAN PR
00935
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-8529
  • Fax:
Mailing address:
  • Phone: 787-756-8529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePR

VIII. Authorized Official

Name: PROF. IVONNE ANGLERO
Title or Position: DIRECTOR
Credential: RD
Phone: 787-756-8529