MEDICARE: ZAYRA M PRESTAMO-TORRES LND, 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	133N00000X	Nutritionist	1063	PR
2	133V00000X	Registered Dietitian	811258	PR

General Provider Information

NPI Number	:	1447568159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAYRA M PRESTAMO-TORRES LND, RD

Provider Business Mailing Address
First Line	:	ANDREA'S COURT 370 CALLE 10
Second Line	:	APT 105
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976-7818
Country	:	US
Telephone Number	:	787-691-2895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 AVE PONCE DE LEON
Second Line	:	COBIANS PLAZA GM-4
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1820
Country	:	US
Telephone Number	:	787-998-0493
Fax Number	:

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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