Provider Demographics
NPI:1275146631
Name:VELEZ-BURGOS, TATIANA (MS, RD, LND, CPT)
Entity Type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:
Last Name:VELEZ-BURGOS
Suffix:
Gender:F
Credentials:MS, RD, LND, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 15309
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-9201
Mailing Address - Country:US
Mailing Address - Phone:787-392-9749
Mailing Address - Fax:
Practice Address - Street 1:RD 348 KM 3.0 INTERIOR
Practice Address - Street 2:BO. QUEBRADA GRANDE
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-392-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered