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General NPI Number Information
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NPI Number | 1124965330
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Entity Type | Organization
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Legal Business Name | NUTRICLINICAL CENTER LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | CALLE ACOSTA ESQUINA CELIS TURABO MEDICAL PRIMARY GROUP
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-566-2696
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Fax |
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Provider Business Mailing Address
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Address Line | URB ALTAPAZ APT 72
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-566-2696
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEFANY HERNANDEZ
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Credential | LND
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Telephone | 787-566-2696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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