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General NPI Number Information
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NPI Number | 1982342044
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Entity Type | Organization
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Legal Business Name | WELLNESS BLANK LLC
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | BELL MONT AT FINCA ELENA HATO NUEVO
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City | GUAYNABO
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State | PR
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Zip | 00970
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Country | US
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Telephone | 787-587-1810
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Fax |
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Provider Business Mailing Address
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Address Line | URB. LAS VEREDAS A-20 CALLE VEREDA REAL
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City | BAYAMON
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State | PR
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Zip | 00961
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Country | US
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Telephone | 787-587-1810
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DESIREE RAMIREZ COLON
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Credential |
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Telephone | 787-587-1810
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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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