Provider Demographics
NPI:1790164655
Name:CURBELO, WANDA M (RD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:M
Last Name:CURBELO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 PONCE BY PASS SUITE 509
Mailing Address - Street 2:PARRA MEDICAL INSTITUTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1382
Mailing Address - Country:US
Mailing Address - Phone:787-284-7150
Mailing Address - Fax:
Practice Address - Street 1:3173 CALLE CAFE
Practice Address - Street 2:URB LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2742
Practice Address - Country:US
Practice Address - Phone:787-284-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered