Healthcare Provider Details

I. General information

NPI: 1861709842
Provider Name (Legal Business Name): MAYTE QUINONES CRUZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2010
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PERLA DEL SUR H 24 REPARTO FLAMINGO
BAYAMON PUERTO RICO
00959
UM

IV. Provider business mailing address

CALLE PERLA DEL SUR H 24 REPARTO FLAMINGO
BAYAMON PUERTO RICO
00959
UM

V. Phone/Fax

Practice location:
  • Phone: 787-447-7204
  • Fax:
Mailing address:
  • Phone: 787-447-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1462
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: