Provider Demographics
NPI:1750808572
Name:GONZALEZ, ANAISA M (LND)
Entity type:Individual
Prefix:MRS
First Name:ANAISA
Middle Name:M
Last Name: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:COND RIBERAS DEL RIO
Mailing Address - Street 2:APT 110 C
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-406-1980
Mailing Address - Fax:
Practice Address - Street 1:465 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3014
Practice Address - Country:US
Practice Address - Phone:787-946-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1667133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist