Provider Demographics
NPI:1508505413
Name:LISBETH NUTRICIONISTA LLC
Entity Type:Organization
Organization Name:LISBETH NUTRICIONISTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRICIONISTA
Authorized Official - Prefix:
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTIAGO MERCEDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-610-8067
Mailing Address - Street 1:PO BOX 8581
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0581
Mailing Address - Country:US
Mailing Address - Phone:787-610-8067
Mailing Address - Fax:
Practice Address - Street 1:2-6 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-610-8067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13549200018OtherREGISTRO COMERCIANTE