Provider Demographics
NPI:1144992835
Name:FERMAINT, MARIELY INES (LDN)
Entity type:Individual
Prefix:
First Name:MARIELY
Middle Name:INES
Last Name:FERMAINT
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:QUINTAS DE CAMPECHE
Mailing Address - Street 2:501 CALLE FLAMBOYAN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-203-2126
Mailing Address - Fax:
Practice Address - Street 1:30 PADIAL ST SUITE 212
Practice Address - Street 2:GATSBY PLAZA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3841
Practice Address - Country:US
Practice Address - Phone:787-653-7555
Practice Address - Fax:305-675-7910
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2131133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist