Basic Information
| Provider Information | |||||||||
| NPI: | 1972121309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ APONTE | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | CRISTINA | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 CALLE ROOSEVELT | ||||||||
| Address2: | |||||||||
| City: | TOA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009533630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9397176886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 715 PONCE DE LEON AVENUE | ||||||||
| Address2: | NUTRITION DEPARTMENT | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009191227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2020 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 2095 | PR | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | 86054770 | PR | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 2095 | 01 | PR | LND | OTHER | 86054770 | 01 | PR | RDN | OTHER |