Provider Demographics
NPI:1265065858
Name:MUNOZ ALONSO, LESLIE E (LND)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:E
Last Name:MUNOZ ALONSO
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:HC 71 BOX 7247
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9556
Mailing Address - Country:US
Mailing Address - Phone:787-385-3301
Mailing Address - Fax:
Practice Address - Street 1:59 CALLE JOSE CELSO BARBOSA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4726
Practice Address - Country:US
Practice Address - Phone:787-385-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1126133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty