Provider Demographics
NPI:1063663409
Name:FELICIANO, ELIZABETH RUIZ (DIETISTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUIZ
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:DIETISTA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:RUIZ
Other - Last Name:FELICIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DIETISTA
Mailing Address - Street 1:4027 CALLE MAJESTAD
Mailing Address - Street 2:URBANIZACION MONTEBELLO
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1271
Mailing Address - Country:US
Mailing Address - Phone:787-223-9517
Mailing Address - Fax:787-849-3055
Practice Address - Street 1:4027 CALLE MAJESTAD
Practice Address - Street 2:URBANIZACION MONTEBELLO
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1271
Practice Address - Country:US
Practice Address - Phone:787-223-9517
Practice Address - Fax:787-849-3055
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR642133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR# 642OtherNUTRITION PROFESSIONAL