Provider Demographics
NPI:1932727161
Name:CARDONA VAQUEZ, NALYAN (LND)
Entity Type:Individual
Prefix:MRS
First Name:NALYAN
Middle Name:
Last Name:CARDONA VAQUEZ
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:STREET ARANJUEZ 641
Mailing Address - Street 2:URB. LA CIMA CIUDAD JARDIN BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-549-8163
Mailing Address - Fax:
Practice Address - Street 1:STREET ARANJUEZ 641
Practice Address - Street 2:URB. LA CIMA CIUDAD JARDIN BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-549-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1984133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist