Provider Demographics
NPI:1285971879
Name:MARRERO COLON, STEPHANIE (LND, RD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MARRERO COLON
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:C20 CAMINO DE DALIAS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3967
Mailing Address - Country:US
Mailing Address - Phone:787-383-0422
Mailing Address - Fax:
Practice Address - Street 1:500 COMERIO AVE. DAVIDSON PLAZA SUITE 10
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered