Provider Demographics
NPI:1801509369
Name:100 PORCIENTO BIENESTAR LLC
Entity type:Organization
Organization Name:100 PORCIENTO BIENESTAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LND
Authorized Official - Phone:787-595-4938
Mailing Address - Street 1:350 BO SUD ARRIBA
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-2424
Mailing Address - Country:US
Mailing Address - Phone:787-347-4406
Mailing Address - Fax:
Practice Address - Street 1:URB BONEVILLE
Practice Address - Street 2:AVE DEGETAU A7
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-347-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty