Provider Demographics
NPI:1316176936
Name:AMY, POLA VANESSA (LND)
Entity type:Individual
Prefix:MS
First Name:POLA
Middle Name:VANESSA
Last Name:AMY
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B14 CALLE 1
Mailing Address - Street 2:URB TINTILLO GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1660
Mailing Address - Country:US
Mailing Address - Phone:787-798-3967
Mailing Address - Fax:787-269-5686
Practice Address - Street 1:B14 CALLE 1
Practice Address - Street 2:URB TINTILLO GARDENS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1660
Practice Address - Country:US
Practice Address - Phone:787-798-3967
Practice Address - Fax:787-269-5686
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered