Provider Demographics
NPI:1356633010
Name:COLON - SANTIAGO, CARMEN I (LND)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:I
Last Name:COLON - SANTIAGO
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:E9 CALLE 9
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3642
Mailing Address - Country:US
Mailing Address - Phone:787-640-9733
Mailing Address - Fax:
Practice Address - Street 1:E9 CALLE 9
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3642
Practice Address - Country:US
Practice Address - Phone:787-640-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR363133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist