MEDICARE: FABIOLA COLON MEDICAL STUDENT

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	390200000X	Student in an Organized Health Care Education/Training Program		PR

General Provider Information

NPI Number	:	1366252892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIOLA COLON MEDICAL STUDENT

Provider Business Mailing Address
First Line	:	400 CALLE CALAF STE 21
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-1313
Country	:	US
Telephone Number	:	787-435-3152
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB. PASEO MAYOR CALLE 7 E 7
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-435-3152
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	06/16/2026

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