Provider Demographics
NPI:1982195798
Name:SANDOVAL, ISAMARIE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:ISAMARIE
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CALLE BRITTON
Mailing Address - Street 2:URB. MONTE ALTO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-647-1736
Mailing Address - Fax:
Practice Address - Street 1:144 CALLE BRITTON
Practice Address - Street 2:URB. MONTE ALTO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-647-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist