Healthcare Provider Details

I. General information

NPI: 1528399813
Provider Name (Legal Business Name): MONICA VALES RD, LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 05/24/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA DE MERCADO SAN GERMAN
SAN GERMAN PR
00683
US

IV. Provider business mailing address

A33 CALLE 12 URB REPARTO UNIVERSIDAD
SAB GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-0737
  • Fax:
Mailing address:
  • Phone: 787-505-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1573
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: