Provider Demographics
NPI:1356021240
Name:GARCIA CORA, AMANDA (LND, RDN)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:GARCIA CORA
Suffix:
Gender:F
Credentials:LND, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363628
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3628
Mailing Address - Country:US
Mailing Address - Phone:787-248-1511
Mailing Address - Fax:
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-248-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2218133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist