MEDICARE: DALGIS SARDINA ORTIZ

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	1047	PR
2	133V00000X	Registered Dietitian	1047	PR

General Provider Information

NPI Number	:	1851511901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALGIS SARDINA ORTIZ

Provider Business Mailing Address
First Line	:	1590 CALLE EARTH
Second Line	:	URB. GOLDEN HILLS
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:	787-474-7346
Fax Number	:	787-474-7346

Provider Business Practice Location Address
First Line	:	URB GOLDEN HILLS
Second Line	:	1590 CALLE EARTH
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:	787-474-7346
Fax Number	:

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	01/17/2012

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