Provider Demographics
NPI:1912563545
Name:BUEN PROVECHO NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:BUEN PROVECHO NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONISR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:AMARILYS
Authorized Official - Last Name:PIMENTEL HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS RDN LND
Authorized Official - Phone:787-579-1036
Mailing Address - Street 1:PO BOX 261869
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-579-1036
Mailing Address - Fax:
Practice Address - Street 1:1629 AVE. PONCE DE LEON
Practice Address - Street 2:URB. CARIBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-579-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty