Provider Demographics
NPI:1396958815
Name:CORREA-SOTOMAYOR, ROSA (MPH, LND)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:CORREA-SOTOMAYOR
Suffix:
Gender:F
Credentials:MPH, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 AVE DE LA CONSTITUCION
Mailing Address - Street 2:COND. MILLENNIUM APT 1010
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2312
Mailing Address - Country:US
Mailing Address - Phone:787-402-8799
Mailing Address - Fax:787-723-8704
Practice Address - Street 1:550 AVE DE LA CONSTITUCION
Practice Address - Street 2:COND. MILLENNIUM APT 1010
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2312
Practice Address - Country:US
Practice Address - Phone:787-402-8799
Practice Address - Fax:787-723-8704
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR366133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education