Healthcare Provider Details

I. General information

NPI: 1154523017
Provider Name (Legal Business Name): MARIBEL GONZALEZ DIETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 AVE PONCE DE LEON HOSPITAL AUXILIO MUTUO, NUTRITION DEPARTMENT
SAN JUAN PR
00909-1958
US

IV. Provider business mailing address

506 VEREDA DEL LAGO LOS ARBOLES
CAROLINA PR
00987-7132
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-752-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number969
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: