Provider Demographics
NPI:1750564498
Name:CARBONELL, ALBA IRIS (LND)
Entity type:Individual
Prefix:MRS
First Name:ALBA
Middle Name:IRIS
Last Name:CARBONELL
Suffix:
Gender:F
Credentials:LND
Other - Prefix:MRS
Other - First Name:ALBA
Other - Middle Name:IRIS
Other - Last Name:CARBONELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LND
Mailing Address - Street 1:110 CALLE PEDRO ARZUAGA E
Mailing Address - Street 2:VILLAS DEL CENTRO APT. # 52
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-6167
Mailing Address - Country:US
Mailing Address - Phone:787-550-5362
Mailing Address - Fax:
Practice Address - Street 1:1715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7951
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1235133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1235OtherLND
PR1235OtherCLE