Provider Demographics
NPI:1689832503
Name:FIGUEROA, SOED
Entity Type:Individual
Prefix:
First Name:SOED
Middle Name:
Last Name:FIGUEROA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7105
Mailing Address - Street 2:PMB 439
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7105
Mailing Address - Country:US
Mailing Address - Phone:787-843-7759
Mailing Address - Fax:787-843-7759
Practice Address - Street 1:375 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3473
Practice Address - Country:US
Practice Address - Phone:787-843-7759
Practice Address - Fax:787-843-7759
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001368133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist