Provider Demographics
NPI:1164662862
Name:LANDRAU COLLAZO, CAROLYN (LND)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:LANDRAU COLLAZO
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO PORTALES DE ALHELI APT. 506
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00969
Mailing Address - Country:UM
Mailing Address - Phone:787-579-7604
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO PORTALES DE ALHELI APT. 506
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00969
Practice Address - Country:UM
Practice Address - Phone:787-579-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1515133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education