Provider Demographics
NPI:1043612971
Name:VIANA-ROSA, DYNORAH
Entity Type:Individual
Prefix:
First Name:DYNORAH
Middle Name:
Last Name:VIANA-ROSA
Suffix:
Gender:F
Credentials:
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 515
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0515
Mailing Address - Country:US
Mailing Address - Phone:787-859-2560
Mailing Address - Fax:787-859-5390
Practice Address - Street 1:CARR 981 KM 15.1
Practice Address - Street 2:BARRIO PUEBLO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-2560
Practice Address - Fax:787-859-5390
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1878133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist