Provider Demographics
NPI:1558161323
Name:ORTIZ ROSADO, SANDRA LUZ (LND)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LUZ
Last Name:ORTIZ ROSADO
Suffix:
Gender:
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:PO BOX 16364
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6364
Mailing Address - Country:US
Mailing Address - Phone:787-671-5706
Mailing Address - Fax:
Practice Address - Street 1:165 STREET #90
Practice Address - Street 2:CENTRO INTERNACIONAL DE MERCADEO
Practice Address - City:GUAYNABO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00908
Practice Address - Country:UM
Practice Address - Phone:787-671-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR970133V00000X
133VN1006X, 133VN1301X, 133VN1501X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics