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General NPI Number Information
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NPI Number | 1174724843
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Entity Type | Individual
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Provider Name | JEANNETE RIVERA CRUZ LIC.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | CASA LINA AVE. #1 SUITE 101 177 ROUTE LOS FILTROS
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City | BAYAMON
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-789-1919
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Fax | 787-789-1921
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Provider Business Mailing Address
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Address Line | PMB 509 P.O.BOX 7891
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City | GUAYNABO
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State | PR
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Zip | 00970-7891
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Country | US
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Telephone | 787-789-1919
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Fax | 787-789-1921
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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 | 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 #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 964
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License Number State | PR
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