Provider Demographics
NPI:1740998277
Name:AVILA COLOM, KRIZIA N (RDN)
Entity type:Individual
Prefix:
First Name:KRIZIA
Middle Name:N
Last Name:AVILA COLOM
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:VILLA CARIBE 60 VIA CUNDEAMOR
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-675-6570
Mailing Address - Fax:
Practice Address - Street 1:VILLA CARIBE 60 VIA CUNDEAMOR
Practice Address - Street 2:HACIENDA SAN JOSE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-0072
Practice Address - Country:US
Practice Address - Phone:787-675-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86104843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered