Organization
BAM PUERTO RICO
Active
Organization
BAM PUERTO RICO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CARRILLO RUSSE LND (NUTRITIONIST)
(787) 510-9452
Entity
Organization
Contact information
Practice address
452 AVE HOSTOS, SAN JUAN, PR 00918-3062
(787) 410-9201
Mailing address
452 AVE HOSTOS, SAN JUAN, PR 00918-3062
(787) 410-9201
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/28/2025
Last updated
11/28/2025
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