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General NPI Number Information
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NPI Number | 1053186452
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Entity Type | Organization
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Legal Business Name | IVITALITY HEALTH
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 76 CALLE UNION JAIME RODRIGUEZ LOCAL A1
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-585-9910
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 AVE ISLA VERDE STE 2-375
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City | CAROLINA
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State | PR
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Zip | 00979-5746
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Country | US
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Telephone | 787-585-9910
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Fax |
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Authorized Official
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Title or Position | DIENA
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Name | MRS. LIMARY SANTIAGO
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Credential |
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Telephone | 787-585-9910
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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