Provider Demographics
NPI:1154087070
Name:GARCIA AVILES, NORKA IRIS
Entity Type:Individual
Prefix:
First Name:NORKA
Middle Name:IRIS
Last Name:GARCIA AVILES
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 3133
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1492 AVE PONCE DE LEON
Practice Address - Street 2:EDIFICIO CENTRO EUROPA 717
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-5017
Practice Address - Fax:787-723-5015
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2117133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2117OtherPROFESSIONAL LICENSE