| Nutrevita Clinic Llc | |
|
Calle Garcia De La Noceda B26 Villas De Rio Grande Rio Grande PR 00745 | |
| (787) 550-2510 | |
| Not Available |
| Full Name | Nutrevita Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | Calle Garcia De La Noceda B26, Rio Grande, Puerto Rico |
| Authorized Official Name and Position | Monica Santiago Gordian (DIRECTOR) |
| Authorized Official Contact | 7875502510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nutrevita Clinic Llc 17166 Goosen Dr Canovanas PR 00729-4508 Ph: (787) 552-2510 | Nutrevita Clinic Llc Calle Garcia De La Noceda B26 Villas De Rio Grande Rio Grande PR 00745 Ph: (787) 550-2510 |
| NPI Number | 1811684210 |
|---|---|
| Provider Enumeration Date | 04/18/2023 |
| Last Update Date | 04/18/2023 |
| Medicare PECOS PAC ID | 8820451297 |
|---|---|
| Medicare Enrollment ID | O20230831004820 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811684210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Monica Santiago Gordian |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1629336771 PECOS PAC ID: 8729237417 Enrollment ID: I20121015000125 |
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