MEDICARE: MISS WILMA CRUZ 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	133V00000X	Registered Dietitian	1476	PR

General Provider Information

NPI Number	:	1174828230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS WILMA CRUZ LND

Provider Business Mailing Address
First Line	:	JOSE SEVERO QUINONES
Second Line	:	EE-16 SANCHEZ ROHNA
City	:	CAROLINA
State	:	PR
Zip	:	00985
Country	:	US
Telephone Number	:	787-203-0211
Fax Number	:	787-730-7073

Provider Business Practice Location Address
First Line	:	H2 AVE CASTIGLIONI
Second Line	:	BAYAMON GARDEN
City	:	BAYAMON
State	:	PR
Zip	:	00957-2427
Country	:	US
Telephone Number	:	787-203-0211
Fax Number	:	787-730-7073

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

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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