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General NPI Number Information
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NPI Number | 1508505413
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Entity Type | Organization
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Legal Business Name | LISBETH NUTRICIONISTA LLC
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 2-6 CALLE MUNOZ RIVERA
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-610-8067
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8581
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City | SAN JUAN
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State | PR
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Zip | 00910-0581
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Country | US
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Telephone | 787-610-8067
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Fax |
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Authorized Official
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Title or Position | NUTRICIONISTA
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Name | LIZBETH S SANTIAGO MERCEDES
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Credential |
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Telephone | 787-610-8067
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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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