Provider Demographics
NPI:1891458097
Name:PEREZ RODRIGUEZ, ALEXANDRA G (MHSN, LND)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:G
Last Name:PEREZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MHSN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB VEREDAS DE YAUCO
Mailing Address - Street 2:CALLE RAMAL 307
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:939-335-1216
Mailing Address - Fax:
Practice Address - Street 1:13B CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3654
Practice Address - Country:US
Practice Address - Phone:787-235-7013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2035133NN1002X, 133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty