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General NPI Number Information
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NPI Number | 1174443600
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Entity Type | Organization
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Legal Business Name | MOG NUTRICION CLINICA LLC
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 4NN4 VIA GEORGINA
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City | CAROLINA
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State | PR
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Zip | 00983-4746
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Country | US
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Telephone | 787-603-9706
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CALLE FLORIDIANO APT 2205
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City | CAROLINA
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State | PR
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Zip | 00987-7708
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Country | US
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Telephone | 787-603-9706
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Fax |
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Authorized Official
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Title or Position | NUTRITIONIST
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Name | MRS. MARIELY OLIVERO
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Credential | MHSCN, LND
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Telephone | 787-307-0844
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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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