Provider Demographics
NPI:1891563128
Name:CACERES, YAMIL ANGEL (LND,CND)
Entity Type:Individual
Prefix:
First Name:YAMIL
Middle Name:ANGEL
Last Name:CACERES
Suffix:
Gender:M
Credentials:LND,CND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANS DEL NORTE NK3 CAMINO DE BUSTAMANTE
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4829
Mailing Address - Country:US
Mailing Address - Phone:787-635-6745
Mailing Address - Fax:
Practice Address - Street 1:MANS DEL NORTE NK3 CAMINO DE BUSTAMANTE
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4829
Practice Address - Country:US
Practice Address - Phone:787-635-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2182133NN1002X, 133V00000X, 133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered