Provider Demographics
NPI:1972853745
Name:GONZALEZ, CLARISA (LND)
Entity Type:Individual
Prefix:MRS
First Name:CLARISA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PADIAL ST.
Mailing Address - Street 2:GATSBY PLAZA SUITE 212
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-210-6995
Mailing Address - Fax:787-653-7555
Practice Address - Street 1:30 PADIAL ST.
Practice Address - Street 2:GATSBY PLAZA SUITE 212
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-210-6995
Practice Address - Fax:787-653-7555
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1241133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education