MEDICARE: MRS. SANDRA I 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	103TC1900X	Counseling Psychologist	2957	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2957	OTHER	PR	DEPARMENT OF HEALTH

General Provider Information

NPI Number	:	1831354141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA I COLON

Provider Business Mailing Address
First Line	:	PO BOX 366101
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-6101
Country	:	US
Telephone Number	:	787-399-5056
Fax Number	:

Provider Business Practice Location Address
First Line	:	LA RIVIERA 105 MEDICAL CENTER PLAZA
Second Line	:	C/3 SE LC 15
City	:	SAN JUAN
State	:	PR
Zip	:	00926-0001
Country	:	US
Telephone Number	:	787-399-5056
Fax Number	:

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	07/25/2008

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Directions to “ MRS. SANDRA I COLON ” Practice Location

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