Provider Demographics
NPI:1639627946
Name:ACEVEDO GONZALEZ, ISAMARYS (LND)
Entity type:Individual
Prefix:
First Name:ISAMARYS
Middle Name:
Last Name:ACEVEDO GONZALEZ
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 2 BOX 4757
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-9535
Mailing Address - Country:US
Mailing Address - Phone:787-387-5655
Mailing Address - Fax:
Practice Address - Street 1:CARR 493 KM 0.5
Practice Address - Street 2:MEDICAL AND PROFESSIONAL OFFICE PLAZA SUITE 124
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-544-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1982133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education