Provider Demographics
NPI:1568753572
Name:CASIANO, NYDIA MARGARITA (NUTRITION)
Entity Type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:MARGARITA
Last Name:CASIANO
Suffix:
Gender:F
Credentials:NUTRITION
Other - Prefix:MRS
Other - First Name:NYDIA
Other - Middle Name:MARGARITA
Other - Last Name:CASIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSE IN NUTRITION
Mailing Address - Street 1:99 GUILLERMO RIEFKHOL SREET
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0000
Mailing Address - Country:US
Mailing Address - Phone:787-839-4320
Mailing Address - Fax:787-271-0004
Practice Address - Street 1:99 GUILLERMO RIEFKHOL SREET
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-0000
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:787-271-0004
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00871133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR000871OtherLICENSE IN NUTRITION