Provider Demographics
NPI:1265869432
Name:COLOMBANI, CARLA NATALIA (DIETITIAN)
Entity type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:NATALIA
Last Name:COLOMBANI
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CALLE MORELL CAMPOS
Mailing Address - Street 2:VILLA PALMERAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-4303
Mailing Address - Country:US
Mailing Address - Phone:787-996-1117
Mailing Address - Fax:
Practice Address - Street 1:715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPT.
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00909-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7951
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1633133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1633OtherDIETICIAN'S LICENSE