Healthcare Provider Details

I. General information

NPI: 1063091999
Provider Name (Legal Business Name): NUTRIKA LOW PROFIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 421 DALIAS STREET URBANIZACION LOS PINOS
YAUCO PR
00698
US

IV. Provider business mailing address

# 421 DALIAS STREET URBANIZACION LOS PINOS
YAUCO PR
00698
US

V. Phone/Fax

Practice location:
  • Phone: 787-981-0949
  • Fax:
Mailing address:
  • Phone: 787-981-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: YANIRA GALARZA
Title or Position: PRESIDENT
Credential: LND
Phone: 787-981-0949