Provider Demographics
NPI:1699486142
Name:HERNANDEZ PEREZ, STEFANY (NUTRICIONISTA)
Entity type:Individual
Prefix:MRS
First Name:STEFANY
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:F
Credentials:NUTRICIONISTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB ALTAPAZ APARTADO 72
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-566-2696
Mailing Address - Fax:787-705-7924
Practice Address - Street 1:BO TIERRA SANTA CARR 149 KM 58 HM 9 URB LAS ALONDRAS
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-705-6550
Practice Address - Fax:787-705-7924
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2065133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty