MEDICARE: MISS DENNICE A MINER LUGO 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
1	133V00000X	Registered Dietitian	1381	PR

General Provider Information

NPI Number	:	1285951129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DENNICE A MINER LUGO RD

Provider Business Mailing Address
First Line	:	3 CALLE CLEMENCEAU
Second Line	:	CONDOMINIO SAN RAFAEL ARCANGEL APT 1
City	:	SAN JUAN
State	:	PR
Zip	:	00907
Country	:	US
Telephone Number	:	787-243-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	787 CALLE HOWARD
Second Line	:	UNIVERSITY GARDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4027
Country	:	US
Telephone Number	:	787-243-6604
Fax Number	:

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

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	04/18/2017

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