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General NPI Number Information
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NPI Number | 1639636541
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Entity Type | Organization
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Legal Business Name | HEALTHY BODY FACTORY, INC
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | CARR 315 KM 1.3 BO SABANA YEGUAS
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City | LAJAS
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State | PR
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Zip | 00667-9066
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Country | US
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Telephone | 787-616-2373
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Fax | 787-899-2836
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Provider Business Mailing Address
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Address Line | HC 1 BOX 7365
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City | LAJAS
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State | PR
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Zip | 00667-9066
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Country | US
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Telephone | 787-616-2373
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Fax | 787-899-2836
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIZMARY NAZARIO-IRIZARRY
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Credential | M.D.
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Telephone | 787-616-2373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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