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NPI Code Detail

MEDICARE: MR. DANNY BOULOUS JAGHAB RD

MEDICARE: MR. DANNY BOULOUS JAGHAB RD
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
1133V00000XRegistered DietitianDT06267TX

General Provider Information

NPI Number : 1174805659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANNY BOULOUS JAGHAB RD
Provider Business Mailing Address
First Line : 822 DONA JUANA ST
Second Line : URBANA LAS COLINAS
City : FT BUCHANAN
State : PUERTO RICO
Zip : 00934
Country : UM
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 822 DONA JUANA ST
Second Line :
City : FT BUCHANAN
State : PUERTO RICO
Zip : 00934
Country : UM
Telephone Number : 787-691-7427
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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