Provider Demographics
NPI:1093011363
Name:CALZADA ROSARIO, MICHELLE M (RD,LND)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:CALZADA ROSARIO
Suffix:
Gender:F
Credentials:RD,LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 7 A2 #5 BERWIND ESTATES
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-644-1185
Mailing Address - Fax:
Practice Address - Street 1:STREET 7 A2 #5 BERWIND ESTATES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-644-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1591133NN1002X
PR1004734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education