Provider Demographics
NPI:1851511901
Name:SARDINA ORTIZ, DALGIS
Entity Type:Individual
Prefix:
First Name:DALGIS
Middle Name:
Last Name:SARDINA ORTIZ
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 1:1590 CALLE EARTH
Mailing Address - Street 2:URB. GOLDEN HILLS
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-474-7346
Mailing Address - Fax:787-474-7346
Practice Address - Street 1:URB GOLDEN HILLS
Practice Address - Street 2:1590 CALLE EARTH
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-474-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1047133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR53518Medicare ID - Type Unspecified