Healthcare Provider Details

I. General information

NPI: 1235376765
Provider Name (Legal Business Name): LILLIAN RODRIGUEZ LND, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AVE PERIFERAL 1111-A COND CUIDAD UNIVERSITARIA
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

1 AVE. PERIFERAL 1111-A COND. CIUDAD UNIVERSITARIA
TRUJILLO ALTO PR
00976-2124
US

V. Phone/Fax

Practice location:
  • Phone: 787-374-1402
  • Fax:
Mailing address:
  • Phone: 787-374-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number460
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: