Provider Demographics
NPI:1881369965
Name:SEMIDEY-MORALES, MARISOL (LND)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:SEMIDEY-MORALES
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:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-0535
Mailing Address - Country:US
Mailing Address - Phone:939-217-4786
Mailing Address - Fax:
Practice Address - Street 1:536 AVE VICTORIA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4623
Practice Address - Country:US
Practice Address - Phone:787-658-6218
Practice Address - Fax:787-658-7116
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2021133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist