1124203419 NPI number — MRS. EMILY BURGOS LND DIETITIAN

Table of content: MRS. EMILY BURGOS LND DIETITIAN (NPI 1124203419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124203419 NPI number — MRS. EMILY BURGOS LND DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGOS
Provider First Name:
EMILY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LND DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124203419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2225 PARRA MEDICAL INSTITUTE
Provider Second Line Business Mailing Address:
SUITE 509 NUTRITIONAL AND METABOLISM CENTER
Provider Business Mailing Address City Name:
PUERTO RICO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00717-1382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-284-7150
Provider Business Mailing Address Fax Number:
787-842-1199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 PARRA MEDICAL INSTITUTE
Provider Second Line Business Practice Location Address:
SUITE 509 NUTRITIONAL AND METABOLISM CENTER
Provider Business Practice Location Address City Name:
PUERTO RICO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-284-7150
Provider Business Practice Location Address Fax Number:
787-842-1199
Provider Enumeration Date:
01/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1380 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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