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General NPI Number Information
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NPI Number | 1801509369
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Entity Type | Organization
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Legal Business Name | 100 PORCIENTO BIENESTAR LLC
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Dates
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Enumeration Date | 12/29/2022
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | URB BONEVILLE AVE DEGETAU A7
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-347-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 350 BO SUD ARRIBA
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City | CIDRA
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State | PR
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Zip | 00739-2424
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Country | US
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Telephone | 787-347-4406
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS YADIRA ORTIZ
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Credential | LND
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Telephone | 787-595-4938
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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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