Healthcare Provider Details

I. General information

NPI: 1235338161
Provider Name (Legal Business Name): BEATRIZ E RADA N.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A18 CALLE 15A
SAN JUAN PR
00924-5842
US

IV. Provider business mailing address

A18 CALLE 15A
SAN JUAN PR
00924-5842
US

V. Phone/Fax

Practice location:
  • Phone: 787-319-6106
  • Fax:
Mailing address:
  • Phone: 787-319-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1334
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: