Provider Demographics
NPI:1972103828
Name:LACLAUSTRA, ANGELICA MARIA (BS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:MARIA
Last Name:LACLAUSTRA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:ANGELES
Mailing Address - State:PR
Mailing Address - Zip Code:00611-0245
Mailing Address - Country:US
Mailing Address - Phone:787-453-6557
Mailing Address - Fax:
Practice Address - Street 1:PR 129 KM 15.1
Practice Address - Street 2:SUITE #3 FIRST FLOOR
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-453-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1907133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist