Healthcare Provider Details

I. General information

NPI: 1790153070
Provider Name (Legal Business Name): NATACHA GUILLOTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-E CARR 199 COND. COLINA REAL,
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 364361
SAN JUAN PR
00936-4361
US

V. Phone/Fax

Practice location:
  • Phone: 787-231-6698
  • Fax:
Mailing address:
  • Phone: 787-231-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1905
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: