Provider Demographics
NPI:1063101020
Name:RIVERA COLON, VILMARY (RD)
Entity type:Individual
Prefix:
First Name:VILMARY
Middle Name:
Last Name:RIVERA COLON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:VIE
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:900 ESTELLE DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4540
Mailing Address - Country:US
Mailing Address - Phone:817-664-3390
Mailing Address - Fax:
Practice Address - Street 1:900 ESTELLE DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-4540
Practice Address - Country:US
Practice Address - Phone:817-664-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered