Active NPI
Ismarie Raldiris, RD, IBCLC
- Nutritionist
- Caguas, PR
National Provider Identifier
1275293128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 1697
- Practice address
- 500 Grand Blvd Los Prados Apt 6102
Caguas, PR 00727-3412 - Phone
- (787) 633-8677
- NPI assigned
- Dec 20, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Non-RN) | 174N00000X | L-86786 | ||
| Nutritionist | 133N00000X | 1697 | PR | Primary |
| Registered Dietitian | 133V00000X | 1069646 |
Addresses
Primary practice location
500 Grand Blvd Los Prados Apt 6102
Caguas, PR 00727-3412
Mailing address
500 Grand Blvd Los Prados Apt 6102
Caguas, PR 00727-3412
Phone (787) 633-8677
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 |
|---|---|---|---|
| 1697 | PR | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639958400000",
"number": "1275293128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 GRAND BLVD LOS PRADOS APT 6102",
"city": "CAGUAS",
"state": "PR",
"postal_code": "007273412",
"telephone_number": "787-633-8677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 GRAND BLVD LOS PRADOS APT 6102",
"city": "CAGUAS",
"state": "PR",
"postal_code": "007273412",
"telephone_number": "787-633-8677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RALDIRIS",
"first_name": "ISMARIE",
"credential": "RD, IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-20",
"last_updated": "2021-12-20",
"certification_date": "2021-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": null,
"license": "L-86786",
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "PR",
"license": "1697",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "1069646",
"primary": false
}
],
"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 Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.