Healthcare Provider Details

I. General information

NPI: 1760627350
Provider Name (Legal Business Name): WALESKA RODRIGUEZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 09/26/2020
Certification Date: 09/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B16 CALLE BEACON
SAN JUAN PR
00926-1433
US

IV. Provider business mailing address

B16 CALLE BEACON
SAN JUAN PR
00926-1433
US

V. Phone/Fax

Practice location:
  • Phone: 787-923-1735
  • Fax:
Mailing address:
  • Phone: 787-923-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1330
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number1330
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1330
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: