# NUTREVITA CLINIC LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811684210
- **Authorized official:** MONICA SANTIAGO GORDIAN RDN, LND, CDCES (DIRECTOR)
- **Authorized official phone:** (787) 550-2510

## Contact information

- **Practice address:** CALLE GARCIA DE LA NOCEDA B26, VILLAS DE RIO GRANDE, RIO GRANDE, PR 00745
- **Practice address phone:** (787) 550-2510
- **Mailing address:** 17166 GOOSEN DR, CANOVANAS, PR 00729-4508
- **Mailing address phone:** (787) 552-2510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/18/2023
- **Last updated:** 04/18/2023