Provider Demographics
NPI:1588445142
Name:NUTRE-VIDA CLINIC LLC
Entity type:Organization
Organization Name:NUTRE-VIDA CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-487-9142
Mailing Address - Street 1:PO BOX 1061
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1061
Mailing Address - Country:US
Mailing Address - Phone:787-487-9142
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 891 KM 0.1 SUITE 1 VILLA ORO PLAZA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-617-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty