Provider Demographics
NPI:1982819652
Name:PRACTICA INTRAMURAL DE NUTRICION
Entity Type:Organization
Organization Name:PRACTICA INTRAMURAL DE NUTRICION
Other - Org Name:PRACTICA INTRAMURAL - EPS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLERO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:787-756-8529
Mailing Address - Street 1:GALINDE ST OFFICE G-12
Mailing Address - Street 2:NUTRITION CLINIC - EPS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935
Mailing Address - Country:US
Mailing Address - Phone:787-756-8529
Mailing Address - Fax:
Practice Address - Street 1:GALINDE ST OFFICE G-12
Practice Address - Street 2:NUTRITION CLINIC - EPS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-756-8529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty