MEDICARE: LORENA MICHELLE DIAZ COLON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	022688	PR

General Provider Information

NPI Number	:	1265059893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENA MICHELLE DIAZ COLON MD

Provider Business Mailing Address
First Line	:	PO BOX 560
Second Line	:
City	:	HATILLO
State	:	PR
Zip	:	00659-0560
Country	:	US
Telephone Number	:	787-552-8789
Fax Number	:	787-879-3995

Provider Business Practice Location Address
First Line	:	175 CALLE SAN FELIPE
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4605
Country	:	US
Telephone Number	:	787-879-3995
Fax Number	:	787-879-3995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	06/30/2022

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