Provider Demographics
NPI:1578308961
Name:CASILLAS VICENTE, HEIDY RUBI (MS, LND)
Entity type:Individual
Prefix:
First Name:HEIDY
Middle Name:RUBI
Last Name:CASILLAS VICENTE
Suffix:
Gender:F
Credentials:MS, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CALLE JOAQUIN POUPART
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:939-400-7757
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE JOAQUIN POUPART
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:939-400-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2232133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist