Provider Demographics
NPI:1982342044
Name:WELLNESS BLANK LLC
Entity Type:Organization
Organization Name:WELLNESS BLANK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-587-1810
Mailing Address - Street 1:URB. LAS VEREDAS
Mailing Address - Street 2:A-20 CALLE VEREDA REAL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-587-1810
Mailing Address - Fax:
Practice Address - Street 1:BELL MONT AT FINCA ELENA
Practice Address - Street 2:HATO NUEVO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-587-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty