Provider Demographics
NPI:1700031234
Name:GONZALEZ, SHEILA DAMARIS (LND)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DAMARIS
Last Name:GONZALEZ
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:HC 1 BOX 5840
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9610
Mailing Address - Country:US
Mailing Address - Phone:787-877-0558
Mailing Address - Fax:787-931-9019
Practice Address - Street 1:AEROPUERTO ANTONIO JUARBE SUITE #1
Practice Address - Street 2:CARR2 BO. SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1449133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1449OtherLICENCIA PR