Provider Demographics
NPI:1316441546
Name:VELAZQUEZ ARRIETA, ANGELA (LND)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VELAZQUEZ ARRIETA
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:PO BOX 21823
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-1823
Mailing Address - Country:US
Mailing Address - Phone:787-415-8760
Mailing Address - Fax:
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 202
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3757
Practice Address - Country:US
Practice Address - Phone:787-763-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2041133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2041OtherPROFESSIONAL LICENSE