Provider Demographics
NPI:1952953671
Name:DELGADO ESPADA, ISMARI (LND, ED, ENP-PR)
Entity Type:Individual
Prefix:
First Name:ISMARI
Middle Name:
Last Name:DELGADO ESPADA
Suffix:
Gender:F
Credentials:LND, ED, ENP-PR
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 1776
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-1776
Mailing Address - Country:US
Mailing Address - Phone:787-220-2784
Mailing Address - Fax:
Practice Address - Street 1:B11 CALLE JACABOA
Practice Address - Street 2:URB RIVER VALLEY PARK
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-220-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2064133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist