Provider Demographics
NPI:1386757219
Name:LANDRON-LANDRON, ANGEL L (BS, LND, DE)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:L
Last Name:LANDRON-LANDRON
Suffix:
Gender:M
Credentials:BS, LND, DE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 91 BOX 9471
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-299-1567
Mailing Address - Fax:
Practice Address - Street 1:HC 91 BOX 9471
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9677
Practice Address - Country:US
Practice Address - Phone:787-299-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered