Individual provider Active NPI

Lilliam Isabel Rodriguez, LND

  • Nutrition Education Nutritionist
  • San Juan, PR
National Provider Identifier
1093998734
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition Education NutritionistTaxonomy code 133NN1002X
License
991 Issued in PR
Practice address
1715 Ave Ponce de Leon
Nutrition Dept
San Juan, PR 00909-1958
Phone
(787) 758-2000
Fax
(787) 771-7951
NPI assigned
Dec 17, 2007
Last updated
Dec 17, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education Nutritionist 133NN1002X 991 PR Primary

Addresses

Primary practice location

1715 Ave Ponce de Leon
Nutrition Dept
San Juan, PR 00909-1958

Mailing address

Q12 Calle Hucar
Valle Arriba Heights
Carolina, PR 00983-3449
Phone (787) 367-1734

Other identifiers 1

IdentifierTypeStateIssuer
991OtherPRLND

Other names 1

  • Ms. Lilliam Isabel Rodriguez Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
991PRMDNutrition Education Nutritionist

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Auxilio Mutuio Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1093998734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "Q12 CALLE HUCAR",
            "address_2": "VALLE ARRIBA HEIGHTS",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009833449",
            "telephone_number": "787-367-1734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 AVE PONCE DE LEON",
            "address_2": "NUTRITION DEPT",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009091958",
            "telephone_number": "787-758-2000",
            "fax_number": "787-771-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "LILLIAM",
        "middle_name": "ISABEL",
        "name_prefix": "Ms.",
        "credential": "LND",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PR",
            "license": "991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LND",
            "identifier": "991",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LILLIAM",
            "last_name": "RODRIGUEZ",
            "middle_name": "ISABEL",
            "prefix": "MS.",
            "credential": "LND",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.