Provider Demographics
NPI:1023579646
Name:MORALES IRIZARRY, JOSERIS N (RDN)
Entity Type:Individual
Prefix:
First Name:JOSERIS
Middle Name:N
Last Name:MORALES IRIZARRY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51502
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1502
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:
Practice Address - Street 1:359 AVE HOSTOS SUITE 201
Practice Address - Street 2:OFFICE PARK 4 A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1507
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86054785OtherACADEMY OF NUTRITION AND DIETETICS
PR2085OtherOFFICE OF REGULATION AND CERTIFICATION OF HEALTH PROFESSIONALS