Provider Demographics
NPI:1952982902
Name:COLON RIVERA, MICHELLE MARIE (RDN, LND)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:COLON RIVERA
Suffix:
Gender:F
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:HC 3 BOX 19279
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-9884
Mailing Address - Country:US
Mailing Address - Phone:787-962-7648
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN INOCENCIO REY #38, LAS GRANJAS
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0069
Practice Address - Country:US
Practice Address - Phone:787-962-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86054756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered