Provider Demographics
NPI:1588809941
Name:COLON HERNANDEZ, KEILA (LND, RD)
Entity Type:Individual
Prefix:MRS
First Name:KEILA
Middle Name:
Last Name:COLON HERNANDEZ
Suffix:
Gender:F
Credentials:LND, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ALTURAS DE RIO GRANDE Q 836 CALLE 15
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-3211
Mailing Address - Country:US
Mailing Address - Phone:787-550-5518
Mailing Address - Fax:
Practice Address - Street 1:URB. ALTURAS DE RIO GRANDE Q 836 CALLE 15
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3211
Practice Address - Country:US
Practice Address - Phone:787-550-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1474133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered