Provider Demographics
NPI:1972024891
Name:DIAZ COLON, NEYSA REBECA (LND)
Entity Type:Individual
Prefix:
First Name:NEYSA
Middle Name:REBECA
Last Name:DIAZ COLON
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:PALMANOVA VILLAGE 285 PALMAS INN WAY APT 9-102
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-944-3978
Mailing Address - Fax:
Practice Address - Street 1:PALMANOVA VILLAGE 285 PALMAS INN WAY APT 9102
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-944-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1180133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist