Healthcare Provider Details

I. General information

NPI: 1407411655
Provider Name (Legal Business Name): REINALDO EUGENIO COLON MORILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL TWENTYNINE PALMS 1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278
US

IV. Provider business mailing address

1145 STURGIS RD
TWENTYNINE PALMS CA
92278
US

V. Phone/Fax

Practice location:
  • Phone: 787-643-6545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101275949
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101275949
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: