Healthcare Provider Details

I. General information

NPI: 1023094182
Provider Name (Legal Business Name): NUTRIX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 37 BOX 1870
SAN JUAN PR
00926-9804
US

IV. Provider business mailing address

RR 37 BOX 1870
SAN JUAN PR
00926-9804
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-1550
  • Fax: 787-763-5807
Mailing address:
  • Phone: 787-751-1550
  • Fax: 787-763-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number09-F-1660
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number09-F-1660
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number09-F-1660
License Number StatePR

VIII. Authorized Official

Name: MR. JAIME PLA CORTES
Title or Position: PRESIDENT
Credential: MS
Phone: 787-751-1550