Provider Demographics
NPI:1669010351
Name:ISLAND NATURAL HEALTH FOOD
Entity Type:Organization
Organization Name:ISLAND NATURAL HEALTH FOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PAGAN DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-813-1123
Mailing Address - Street 1:HACIENDA LAS VEGAS
Mailing Address - Street 2:117 CALLE GAVIOTA
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-7003
Mailing Address - Country:US
Mailing Address - Phone:787-813-1123
Mailing Address - Fax:
Practice Address - Street 1:245 CALLE ROSA
Practice Address - Street 2:URB. FERRY BARRANCA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4322
Practice Address - Country:US
Practice Address - Phone:787-813-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier