Provider Demographics
NPI:1265026769
Name:NUTRIVATE, CSP
Entity type:Organization
Organization Name:NUTRIVATE, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-220-9051
Mailing Address - Street 1:L8 CALLE MONTE MEMBRILLO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8023
Mailing Address - Country:US
Mailing Address - Phone:787-220-9051
Mailing Address - Fax:
Practice Address - Street 1:33-5 CALLE 11
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5436
Practice Address - Country:US
Practice Address - Phone:787-225-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty