Provider Demographics
NPI:1962083881
Name:PEREZ ORTIZ, VILMA LIZZETTE (LND)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:LIZZETTE
Last Name:PEREZ ORTIZ
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:COND TORRE DEL CARDENAL
Mailing Address - Street 2:SPH-10 675 CUEVAS BUSTAMANTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-397-1625
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON HEALTH CENTER PISO 2
Practice Address - Street 2:CALLE MANUEL F. ROSSI ESQUINA ISABEL II
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-6590
Practice Address - Fax:787-269-6599
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR831133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist