Provider Demographics
NPI:1598212102
Name:AVILES RODRIGUEZ, MARIANELA (LND)
Entity type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:AVILES RODRIGUEZ
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:GG 29 CALLE 33 OESTE
Mailing Address - Street 2:PRIMERA SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-946-3846
Mailing Address - Fax:
Practice Address - Street 1:GG 29 CALLE 33
Practice Address - Street 2:PRIMERA SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-946-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1930133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist