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General NPI Number Information
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NPI Number | 1912563545
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Entity Type | Organization
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Legal Business Name | BUEN PROVECHO NUTRITION SERVICES LLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 1629 AVE. PONCE DE LEON URB. CARIBE
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-579-1036
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261869
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-579-1036
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Fax |
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Authorized Official
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Title or Position | NUTRITIONISR
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Name | CATHERINE AMARILYS PIMENTEL HERNANDEZ
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Credential | MS RDN LND
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Telephone | 787-579-1036
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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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