Provider Demographics
NPI:1093938201
Name:GARCIA, ELAINE (DIETISTA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DIETISTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 592 K.M. 5.6
Mailing Address - Street 2:BO. AMUELAS # 115
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-2872
Mailing Address - Country:US
Mailing Address - Phone:787-837-6574
Mailing Address - Fax:787-260-0034
Practice Address - Street 1:CARR. 592 K.M. 5.6
Practice Address - Street 2:BO. AMUELAS # 115
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2872
Practice Address - Country:US
Practice Address - Phone:787-837-6574
Practice Address - Fax:787-260-0034
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106612133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR106612OtherLICENSES