Provider Demographics
NPI:1942853932
Name:PARRILLA-CALO, RAIZA M (LND)
Entity Type:Individual
Prefix:MRS
First Name:RAIZA
Middle Name:M
Last Name:PARRILLA-CALO
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:HC 3 BOX 7916
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9771
Mailing Address - Country:US
Mailing Address - Phone:787-642-4548
Mailing Address - Fax:
Practice Address - Street 1:151 AVE OSVALDO MOLINA
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4013
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:787-522-3578
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1585133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty