Provider Demographics
NPI:1124859517
Name:APONTE CASABLANCA, DESIREE M (RDN, LND)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:M
Last Name:APONTE CASABLANCA
Suffix:
Gender:F
Credentials:RDN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSIONES REALES PASEO DE LA REINA J3
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5253
Mailing Address - Country:US
Mailing Address - Phone:787-313-1883
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO CARIBBEAN CINEMA
Practice Address - Street 2:SUITE 201 PLAZA GUAYNABO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5253
Practice Address - Country:US
Practice Address - Phone:787-731-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered