Provider Demographics
NPI:1245043363
Name:MALDONADO COLON, VANESSA MARIE (MPHGERO, LND)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:MALDONADO COLON
Suffix:
Gender:F
Credentials:MPHGERO, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DE SAN FRANCISCO PLAZA II
Mailing Address - Street 2:87 AVE. DE DIEGO SUITE 211
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928
Mailing Address - Country:US
Mailing Address - Phone:787-672-1657
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE SAN FRANCISCO PLAZA LL
Practice Address - Street 2:87 AVE. DE DIEGO SUITE 211
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928-0092
Practice Address - Country:US
Practice Address - Phone:787-672-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered