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General NPI Number Information
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NPI Number | 1649861212
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Entity Type | Organization
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Legal Business Name | NUTRIVATE
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | ROBERTO CLEMENTE AVENUE 33-5
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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 | 787-225-6040
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Fax |
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Provider Business Mailing Address
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Address Line | L8 CALLE MONTE MEMBRILLO
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City | CAROLINA
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State | PR
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Zip | 00987-8023
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Country | US
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Telephone | 787-220-9051
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Fax |
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Authorized Official
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Title or Position | NUTRITIONIST/DIETITIAN
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Name | MRS. SONIA Y CRUZ
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Credential | LND
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Telephone | 787-220-9051
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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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