Provider Demographics
NPI:1083952196
Name:MUNOZ, ELIZABETH (LND)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LND
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 1283
Mailing Address - Street 2:PMB 13
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-1283
Mailing Address - Country:US
Mailing Address - Phone:787-454-5992
Mailing Address - Fax:
Practice Address - Street 1:CALLE VALERIANO MUNOZ
Practice Address - Street 2:#112
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-1283
Practice Address - Country:US
Practice Address - Phone:787-454-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1695133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education