Provider Demographics
NPI:1548569973
Name:COLON MORALES, IXIAN B (LND, RD)
Entity type:Individual
Prefix:MRS
First Name:IXIAN
Middle Name:B
Last Name:COLON MORALES
Suffix:
Gender:F
Credentials:LND, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 GUAMANI
Mailing Address - Street 2:CIUDAD CENTRO
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-948-9411
Mailing Address - Fax:
Practice Address - Street 1:VALLE ARRIBA HTS
Practice Address - Street 2:YAGRUMO ST, AD-1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-948-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1594133N00000X
PR1015845133V00000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist