1457343238 NPI number — NUTRITION CARE, INC.

Table of content: (NPI 1457343238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457343238 NPI number — NUTRITION CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUTRITION CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1457343238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 CALLE ELEANOR ROOSEVELT,
Provider Second Line Business Mailing Address:
URB. EL VEDADO, 1ST FLOOR
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-778-5449
Provider Business Mailing Address Fax Number:
787-780-7475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 CALLE ELEANOR ROOSEVELT
Provider Second Line Business Practice Location Address:
URB. EL VEDADO, 1ST FLOOR
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-778-5449
Provider Business Practice Location Address Fax Number:
787-780-7475
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CONDE
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-778-5449

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  1252490001 , 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)

  • Identifier: 9500048 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 50200 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9000115 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 55273 . This is a "TRIPLE S, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 991269 . This is a "MEDICARE MUCHO MAS (MMM)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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