Provider Demographics
NPI:1871626275
Name:COLON-PEREZ, MARISSA (RD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:COLON-PEREZ
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 1:2002 CALLE CAUDAL
Mailing Address - Street 2:URB. VALLE VERDE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3607
Mailing Address - Country:US
Mailing Address - Phone:787-841-1981
Mailing Address - Fax:
Practice Address - Street 1:2002 CALLE CAUDAL
Practice Address - Street 2:URB. VALLE VERDE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3607
Practice Address - Country:US
Practice Address - Phone:787-841-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ-39692Medicare UPIN
PRQ-39692Medicare UPIN