Healthcare Provider Details

I. General information

NPI: 1104016047
Provider Name (Legal Business Name): SANDRA E ALVARADO RD,LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2615
US

IV. Provider business mailing address

PARQUE EL SENORIAL 2042 BENITO FEIJOO
SAN JUAN PR
00926-6601
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-5559
  • Fax:
Mailing address:
  • Phone: 787-760-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1088
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: