Provider Demographics
NPI:1669628426
Name:NEVAREZ, SANDRA IVETTE (LND)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:IVETTE
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND JARDINES DEL PARQUE # 4101
Mailing Address - Street 2:79 MEDIA LUNA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4929
Mailing Address - Country:US
Mailing Address - Phone:797-367-8975
Mailing Address - Fax:
Practice Address - Street 1:COND JARDINES DEL PARQUE # 4101
Practice Address - Street 2:79 MEDIA LUNA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4929
Practice Address - Country:US
Practice Address - Phone:797-367-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1019133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist