Provider Demographics
NPI:1124464656
Name:GARCIA, MAYRA YAZMIN (LND, RDN)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:YAZMIN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LND, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET H, E-12, URB. GOLDEN GATE II
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-235-3152
Mailing Address - Fax:
Practice Address - Street 1:STREET H, # E-12
Practice Address - Street 2:URB. GOLDEN GATE II
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-235-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1687133N00000X
PR01069672133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered