Provider Demographics
NPI:1780007534
Name:COLBERG, ABDIEL (RDN, LND)
Entity Type:Individual
Prefix:
First Name:ABDIEL
Middle Name:
Last Name:COLBERG
Suffix:
Gender:M
Credentials:RDN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 CALLE SANTA EDUVIGIS
Mailing Address - Street 2:URB SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-209-4440
Mailing Address - Fax:
Practice Address - Street 1:1718 CALLE SANTA EDUVIGIS
Practice Address - Street 2:URB SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-209-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1850133V00000X
PR1069633133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered