Provider Demographics
NPI:1588052211
Name:VIERA-VIERA, MARTA B
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:B
Last Name:VIERA-VIERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CALLE AZALEA
Mailing Address - Street 2:CIUDAD JARDIN1
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4846
Mailing Address - Country:US
Mailing Address - Phone:787-318-6347
Mailing Address - Fax:
Practice Address - Street 1:102 CALLE AZALEA
Practice Address - Street 2:CIUDAD JARDIN1
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4846
Practice Address - Country:US
Practice Address - Phone:787-318-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR614133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist