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General NPI Number Information
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NPI Number | 1023094182
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Entity Type | Organization
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Legal Business Name | NUTRIX INC
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | RR 37 BOX 1870
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City | SAN JUAN
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State | PR
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Zip | 00926-9804
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Country | US
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Telephone | 787-751-1550
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Fax | 787-763-5807
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Provider Business Mailing Address
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Address Line | RR 37 BOX 1870
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City | SAN JUAN
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State | PR
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Zip | 00926-9804
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Country | US
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Telephone | 787-751-1550
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Fax | 787-763-5807
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAIME PLA CORTES
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Credential | MS
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Telephone | 787-751-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 09-F-1660
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 09-F-1660
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 09-F-1660
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License Number State | PR
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