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General NPI Number Information
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NPI Number | 1972853745
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Entity Type | Individual
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Provider Name | CLARISA GONZALEZ LND
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | URB MONTEHIEDRA 165 CALLE PITIRRE
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City | SAN JUAN
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State | PR
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Zip | 00926-7103
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Country | US
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Telephone | 787-210-6995
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Fax | 305-675-7910
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Provider Business Mailing Address
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Address Line | 30 PADIAL ST. GATSBY PLAZA SUITE 212
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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 | 787-210-6995
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Fax | 787-653-7555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1241
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License Number State | PR
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