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General NPI Number Information
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NPI Number | 1316176936
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Entity Type | Individual
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Provider Name | POLA VANESSA AMY LND
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Gender | Female
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | B14 CALLE 1 URB TINTILLO GARDENS
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City | GUAYNABO
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State | PR
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Zip | 00966-1660
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Country | US
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Telephone | 787-798-3967
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Fax | 787-269-5686
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Provider Business Mailing Address
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Address Line | B14 CALLE 1 URB TINTILLO GARDENS
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City | GUAYNABO
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State | PR
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Zip | 00966-1660
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Country | US
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Telephone | 787-798-3967
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Fax | 787-269-5686
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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 | 929
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License Number State | PR
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