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General NPI Number Information
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NPI Number | 1053123059
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Entity Type | Individual
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Provider Name | CARMEN M NEVAREZ LND MHSN IOC SPORT
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Gender | Female
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | MARACAIBO B68 PARK GARDENS SAN JUAN
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City | SAN JUAN, PR
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State | PR
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Zip | 00926-2245
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Country | US
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Telephone | 787-486-8181
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Fax |
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Provider Business Mailing Address
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Address Line | MARACAIBO B68 PARK GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00926-2245
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Country | US
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Telephone | 787-486-8181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 716
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | 716
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License Number State | PR
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