Edwill Burgos-Velazquez, LCDO

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

1897 Issued in PR

Practice address

2 Calle Segundo Bernier
Coamo, PR 00769-3036

Phone

(787) 803-8221

Fax

(787) 537-7071

NPI assigned

Jan 28, 2015

Last updated

Dec 14, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Clinica de Nutricion del Sur LLC

  • Nutrition Education Nutritionist
  • Coamo, PR
  • NPI 1306615091

  Nutrition, Education

  Medicare reassignment NPD

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1679963722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 83",
            "city": "SANTA ISABEL",
            "state": "PR",
            "postal_code": "00757",
            "telephone_number": "787-242-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CALLE SEGUNDO BERNIER",
            "city": "COAMO",
            "state": "PR",
            "postal_code": "007693036",
            "telephone_number": "787-803-8221",
            "fax_number": "787-537-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGOS-VELAZQUEZ",
        "first_name": "EDWILL",
        "credential": "LCDO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-28",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PR",
            "license": "1897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francisco Jose Betancourt Borges, M.D.
• Maria De Los Angeles Blanco Collazo, MS
• Liany Camille Borges
• Brain Base Therapy Center LLC
• Yanitzia Enid Burgos Mateo
• Felix M. Caratini Soto, MD
• Danishka Marie Cardona
• Ida E. Cardona
• Milagros P Carrasquillo
• Luis Antonio Casiano Guio, PSYD

• Nutrition Education Nutritionist in Coamo, PR
• Providers in Coamo, PR by specialty
• Nutrition Education Nutritionist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.