Basic Information
| Provider Information | |||||||||
| NPI: | 1669625364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERDEJO | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LND | ||||||||
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| Mailing Information | |||||||||
| Address1: | UU22 CALLE YUNQUESITO | ||||||||
| Address2: | MANSIONES DE CAROLINA | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009878125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877568907 | ||||||||
| Practice Location | |||||||||
| Address1: | UU22 CALLE YUNQUESITO | ||||||||
| Address2: | MANSIONES DE CAROLINA | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009878125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877568907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 1319 | PR | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.