Provider Demographics
NPI:1003536913
Name:CRUZ COLON, JUAN LUIS (MA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:LUIS
Last Name:CRUZ COLON
Suffix:
Gender:M
Credentials:MA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13289
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-3289
Mailing Address - Country:US
Mailing Address - Phone:919-908-0238
Mailing Address - Fax:
Practice Address - Street 1:4024 STIRRUP CREEK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9464
Practice Address - Country:US
Practice Address - Phone:919-767-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered