Provider Demographics
NPI:1790188944
Name:MAYO ALBURQUERQUE, GERALDINE (RDN)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:MAYO ALBURQUERQUE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CALLE RUBICON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3216
Mailing Address - Country:US
Mailing Address - Phone:787-410-8794
Mailing Address - Fax:
Practice Address - Street 1:715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5032
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86046423133V00000X
PR1861133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1861OtherDIETITIAN LICENSE
PR86046423OtherRDN-DIETITIAN LICENSE