Provider Demographics
NPI:1376989798
Name:BERRIOS, MYRNA (NUTRITIONIST)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B5 TABONUCO STREET GALERIA SAN PATRICIO
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-522-0540
Mailing Address - Fax:787-522-0541
Practice Address - Street 1:B5 CALLE TABONUCO STE 211
Practice Address - Street 2:GALERIA SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3013
Practice Address - Country:US
Practice Address - Phone:787-522-0540
Practice Address - Fax:787-522-0541
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR629133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education