Provider Demographics
NPI:1437481264
Name:PERALES, MARIO FELIX (LND)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:FELIX
Last Name:PERALES
Suffix:
Gender:M
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARQUE DE LA FUENTE C16 BAIROA PARK
Mailing Address - Street 2:C16 BAIROA PARK
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-599-4676
Mailing Address - Fax:
Practice Address - Street 1:C16 PARQ DE LA FUENTE
Practice Address - Street 2:C16 BAIROA PARK
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1231
Practice Address - Country:US
Practice Address - Phone:787-599-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1539133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education