Basic Information
| Provider Information | |||||||||
| NPI: | 1982031548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLON | ||||||||
| FirstName: | MARIELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DIETITIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1933 CALLE M MALDONADO | ||||||||
| Address2: | FAIR VIEW | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009267749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873093301 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 715 AVE PONCE DE LEON | ||||||||
| Address2: | NUTRITION DEPT. | ||||||||
| City: | HATO REY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009175032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2013 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 1682 | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.