Provider Demographics
NPI:1326497702
Name:TU NUTRICION CORPORATION
Entity Type:Organization
Organization Name:TU NUTRICION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:LND
Authorized Official - Phone:787-396-1916
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB 323
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-396-1916
Mailing Address - Fax:
Practice Address - Street 1:1300 CALLE ATENAS
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7807
Practice Address - Country:US
Practice Address - Phone:787-396-1916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1457261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1457OtherDEPARTMENT OF HEALTH OF PUERTO RICO