Provider Demographics
NPI:1548036494
Name:COLON, ANDREA (RD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB ESTANCIAS DE SAN FERNANDO CALLE6 E2
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-909-4054
Mailing Address - Fax:
Practice Address - Street 1:AVE ROBERTO SANCHEZ VILELLA A6
Practice Address - Street 2:CASTELLANA GARDENS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-7897
Practice Address - Fax:787-768-0689
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2249133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered