Provider Demographics
NPI:1306615091
Name:CLINICA DE NUTRICION DEL SUR LLC
Entity type:Organization
Organization Name:CLINICA DE NUTRICION DEL SUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC
Authorized Official - Prefix:
Authorized Official - First Name:EDWILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-242-6225
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0083
Mailing Address - Country:US
Mailing Address - Phone:787-226-1176
Mailing Address - Fax:
Practice Address - Street 1:CALLE SEGUNDO BERNIER
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-803-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty