Provider Demographics
NPI:1346324571
Name:MONGIL, MARIA A (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:MONGIL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN LEANDRO 430
Mailing Address - Street 2:SAGRADO CORAZON
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0926
Mailing Address - Country:US
Mailing Address - Phone:787-758-7575
Mailing Address - Fax:787-641-8366
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-758-7575
Practice Address - Fax:787-641-8366
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR908133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered