Provider Demographics
NPI:1184748089
Name:LEBRON, DAYANARA (LND,CAWM,DE)
Entity type:Individual
Prefix:
First Name:DAYANARA
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:LND,CAWM,DE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CALLE BETANCES
Mailing Address - Street 2:FLORAL PARK
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3840
Mailing Address - Country:US
Mailing Address - Phone:787-754-8224
Mailing Address - Fax:
Practice Address - Street 1:COND SAN JORGE
Practice Address - Street 2:#253 2ND FLOOR
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3359
Practice Address - Country:US
Practice Address - Phone:787-638-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1185133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education