Healthcare Provider Details

I. General information

NPI: 1649114984
Provider Name (Legal Business Name): NUTRIENDO PR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 AVE PONCE DE LEON STE 301
SAN JUAN PR
00907-4023
US

IV. Provider business mailing address

PO BOX 367320
SAN JUAN PR
00936-7320
US

V. Phone/Fax

Practice location:
  • Phone: 787-222-0528
  • Fax:
Mailing address:
  • Phone: 787-222-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGELA DIAZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-223-7000