Healthcare Provider Details

I. General information

NPI: 1558161323
Provider Name (Legal Business Name): SANDRA LUZ ORTIZ ROSADO LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 STREET #90 CENTRO INTERNACIONAL DE MERCADEO
GUAYNABO PUERTO RICO
00908
UM

IV. Provider business mailing address

PO BOX 16364
SAN JUAN PR
00908-6364
US

V. Phone/Fax

Practice location:
  • Phone: 787-671-5706
  • Fax:
Mailing address:
  • Phone: 787-671-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number970
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: