Provider Demographics
NPI:1437622636
Name:COLLADO, CELIMAR (RDN)
Entity Type:Individual
Prefix:
First Name:CELIMAR
Middle Name:
Last Name:COLLADO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB 347
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-999-6200
Mailing Address - Fax:787-625-8780
Practice Address - Street 1:138 AVE WINSTON CHURCHILL
Practice Address - Street 2:PMB 347
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-999-6200
Practice Address - Fax:787-625-8780
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86020997133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered