Provider Demographics
NPI:1902303050
Name:NUTRISECTOR LLC
Entity Type:Organization
Organization Name:NUTRISECTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:SISCO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LND, DYSC,DEP
Authorized Official - Phone:787-242-2193
Mailing Address - Street 1:77 CALLE ZIRCONIA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2378
Mailing Address - Country:US
Mailing Address - Phone:787-242-2193
Mailing Address - Fax:
Practice Address - Street 1:CARR 112 KM 1.4 INT
Practice Address - Street 2:AVE AGUSTIN RAMOS CALERO HOSPITAL CIMA ISABELA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0979
Practice Address - Country:US
Practice Address - Phone:787-242-2193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center