MEDICARE: JOAN E COLON

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	103TC0700X	Clinical Psychologist	7513	PR

General Provider Information

NPI Number	:	1356047427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN E COLON

Provider Business Mailing Address
First Line	:	LAS DELICIAS II 4023 FIDELIA MATHEW
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728
Country	:	US
Telephone Number	:	254-458-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAS DELICIAS II 4023 FIDELIA MATHEW
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728
Country	:	US
Telephone Number	:	254-458-3749
Fax Number	:

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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Directions to “ JOAN E COLON ” Practice Location

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