Healthcare Provider Details

I. General information

NPI: 1134496029
Provider Name (Legal Business Name): LILLIAM RODRIGUEZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 693 266 BARRIO BRENA
VEGA ALTA PUERTO RICO
00692
UM

IV. Provider business mailing address

COND VEREDAS DEL MAR APAT 3-102
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-531-9227
  • Fax:
Mailing address:
  • Phone: 787-688-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1367
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: