MEDICARE: DYNORAH VIANA-ROSA RD, LND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	1878	PR

General Provider Information

NPI Number	:	1043612971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYNORAH VIANA-ROSA RD, LND

Provider Business Mailing Address
First Line	:	URB. SAN PEDRO, CALLE SAN MATEO, B1
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949-5406
Country	:	US
Telephone Number	:	787-309-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR 863 KM 1.5
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949-5406
Country	:	US
Telephone Number	:	939-355-0714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	06/18/2026

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