=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831372572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NITZA ENID PEREZ LND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 12/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1715 AVE PONCE DE LEON NUTRITION DEPT.
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-758-2000
-----------------------------------------------------
Fax | 787-771-7951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60024 CALLE BUCARE URB BOSQUE DORADO
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-9671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-638-4445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number | 1001
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------