Provider Demographics
NPI:1215188503
Name:ASTACIO, LIANA MARIA (LND)
Entity Type:Individual
Prefix:MRS
First Name:LIANA
Middle Name:MARIA
Last Name:ASTACIO
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 1:44 QUEBRADA GRANDE
Mailing Address - Street 2:URB. CORRIENTES
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6180
Mailing Address - Country:US
Mailing Address - Phone:787-644-3013
Mailing Address - Fax:
Practice Address - Street 1:44 QUEBRADA GRANDE
Practice Address - Street 2:URB. CORRIENTES
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6180
Practice Address - Country:US
Practice Address - Phone:787-644-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered