Provider Demographics
NPI:1801591862
Name:MOWZOUN, NEDA (MS, CNS)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:MOWZOUN
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 AVE MAGDALENA
Mailing Address - Street 2:CONDO PLAZA STELLA APT 1902
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-462-5583
Mailing Address - Fax:
Practice Address - Street 1:1550 AVE PONCE DE LEON STE 3B
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1762
Practice Address - Country:US
Practice Address - Phone:787-793-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18539133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist