Provider Demographics
NPI:1427541606
Name:LCDA.MORAIMA GARCIA VERGARA
Entity Type:Organization
Organization Name:LCDA.MORAIMA GARCIA VERGARA
Other - Org Name:LCDA.MORAIMA GARCIA VERGARA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NUTRITIONIST/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MORAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-318-2041
Mailing Address - Street 1:104 CALLE LUIS MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 CALLE VICTORIA STE 17 LEGACY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3337
Practice Address - Country:US
Practice Address - Phone:787-318-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty