Provider Demographics
NPI:1013140748
Name:TRAK-FELLERMEIER, MARIA ANGELICA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:TRAK-FELLERMEIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANGELICA
Other - Last Name:TRAK MIRELES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LND, MPH
Mailing Address - Street 1:400 CARRETERA 176
Mailing Address - Street 2:#101 CONDOMINIO PASEO DEL ROCIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6677
Mailing Address - Country:US
Mailing Address - Phone:787-998-1548
Mailing Address - Fax:
Practice Address - Street 1:CALLE 16 V1 CDT VILLA LOS SANTOS
Practice Address - Street 2:URB VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1535133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist