Provider Demographics
NPI:1588257869
Name:RODRIGUEZ ALICEA, BARBARA AVELISSE (LND)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:AVELISSE
Last Name:RODRIGUEZ ALICEA
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 372948
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2948
Mailing Address - Country:US
Mailing Address - Phone:787-516-9854
Mailing Address - Fax:
Practice Address - Street 1:A15 CALLE FLAMBOYAN
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4510
Practice Address - Country:US
Practice Address - Phone:787-516-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1943133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education