Active NPI
Ivelisa Marin
- Nutritionist
- Caguas, PR
National Provider Identifier
1124559323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 1454
- Practice address
- 28 Calle 2
Avenida Bairoa
Caguas, PR 00000-0725 - Phone
- (787) 605-3510
- NPI assigned
- Mar 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 1454 | PR | Primary |
Addresses
Primary practice location
28 Calle 2
Avenida Bairoa
Caguas, PR 00000-0725
Mailing address
Urb. Borinquen Valley C/ Martillo 219
Caguas, PUERTO RICO 00725
UM
Phone (787) 605-3510
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1454 | PR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490054400000",
"number": "1124559323",
"addresses": [
{
"country_code": "UM",
"country_name": "United States Minor Outlying Islands",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "URB. BORINQUEN VALLEY C/ MARTILLO 219",
"city": "CAGUAS",
"state": "PUERTO RICO",
"postal_code": "00725",
"telephone_number": "787-605-3510",
"fax_number": "787-727-5561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 CALLE 2",
"address_2": "AVENIDA BAIROA",
"city": "CAGUAS",
"state": "PR",
"postal_code": "000000725",
"telephone_number": "787-605-3510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIN",
"first_name": "IVELISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-21",
"last_updated": "2017-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "PR",
"license": "1454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caguas, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.