Provider Demographics
NPI:1841500931
Name:PIQUER, YVELISSE (REGISTER DIETITIAN)
Entity type:Individual
Prefix:
First Name:YVELISSE
Middle Name:
Last Name:PIQUER
Suffix:
Gender:F
Credentials:REGISTER DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CALLE SANTA CRUZ
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6910
Mailing Address - Country:US
Mailing Address - Phone:787-740-8040
Mailing Address - Fax:787-740-8060
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 307
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-740-8040
Practice Address - Fax:787-740-8060
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRR 495967133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR573OtherPUERTO RICO LICENSE