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General NPI Number Information
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NPI Number | 1174828230
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Entity Type | Individual
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Provider Name | WILMA CRUZ LND
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Gender | Female
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | H2 AVE CASTIGLIONI BAYAMON GARDEN
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City | BAYAMON
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State | PR
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Zip | 00957-2427
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Country | US
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Telephone | 787-203-0211
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Fax | 787-730-7073
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Provider Business Mailing Address
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Address Line | JOSE SEVERO QUINONES EE-16 SANCHEZ ROHNA
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-203-0211
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Fax | 787-730-7073
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1476
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License Number State | PR
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