Provider Demographics
NPI:1689104978
Name:DIAZ MORALES, ABNERIS (LND)
Entity Type:Individual
Prefix:
First Name:ABNERIS
Middle Name:
Last Name:DIAZ MORALES
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CALLE JOSE CELSO BARBOSA
Mailing Address - Street 2:BARRIO AMELIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00965
Mailing Address - Country:US
Mailing Address - Phone:787-946-5411
Mailing Address - Fax:787-986-7525
Practice Address - Street 1:923 AVE CAMPO RICO
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-946-5411
Practice Address - Fax:787-986-7525
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1364133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty