Provider Demographics
NPI:1962643155
Name:YAGUAL, JORGE A (RD)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:A
Last Name:YAGUAL
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 7TH AVE
Mailing Address - Street 2:SUITE 4S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1854
Mailing Address - Country:US
Mailing Address - Phone:917-803-0128
Mailing Address - Fax:
Practice Address - Street 1:2411 7TH AVE
Practice Address - Street 2:SUITE 4S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1854
Practice Address - Country:US
Practice Address - Phone:917-803-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered