Provider Demographics
NPI:1831221092
Name:SANJURJO, LIZAMAR (LND)
Entity type:Individual
Prefix:
First Name:LIZAMAR
Middle Name:
Last Name:SANJURJO
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:JARDINES DE RIO GRANDE
Mailing Address - Street 2:C 51 BJ 675
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2632
Mailing Address - Country:US
Mailing Address - Phone:787-955-3444
Mailing Address - Fax:787-886-3254
Practice Address - Street 1:URBANIZACION VILLAS DE LOIZA
Practice Address - Street 2:ALTOS FARMACIA MEDINA 2
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-955-3444
Practice Address - Fax:787-886-3254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered