Provider Demographics
NPI:1487067831
Name:ALICEA-POU, ILSIA (LND)
Entity type:Individual
Prefix:MRS
First Name:ILSIA
Middle Name:
Last Name:ALICEA-POU
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:APARTADO 220 MERCEDITA P.R. 00715-0220
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1415
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:787-284-4228
Practice Address - Street 1:AVE. HOSTOS 1034 PONCE, P.R. 00716-1415
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1415
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:787-284-4228
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1101133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist