Provider Demographics
NPI:1114069507
Name:ANGLERO, IVONNE (RD, LND, MMSC)
Entity Type:Individual
Prefix:PROF
First Name:IVONNE
Middle Name:
Last Name:ANGLERO
Suffix:
Gender:F
Credentials:RD, LND, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PONCE DE LEON
Mailing Address - Street 2:22 STREET #191
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4433
Mailing Address - Country:US
Mailing Address - Phone:787-756-8529
Mailing Address - Fax:787-756-8529
Practice Address - Street 1:INGENIERO GALINDEZ STREET CPRS LOBBY
Practice Address - Street 2:TERRENOS DE CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-756-8529
Practice Address - Fax:787-756-8529
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00579133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered