Provider Demographics
NPI:1053123059
Name:NEVAREZ, CARMEN M (LND MHSN IOC SPORT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:LND MHSN IOC SPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARACAIBO B68 PARK GARDENS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2245
Mailing Address - Country:US
Mailing Address - Phone:787-486-8181
Mailing Address - Fax:
Practice Address - Street 1:MARACAIBO B68 PARK GARDENS SAN JUAN
Practice Address - Street 2:
Practice Address - City:SAN JUAN, PR
Practice Address - State:PR
Practice Address - Zip Code:00926-2245
Practice Address - Country:US
Practice Address - Phone:787-486-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR716133N00000X, 133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133N00000XDietary & Nutritional Service ProvidersNutritionist