Healthcare Provider Details

I. General information

NPI: 1649350406
Provider Name (Legal Business Name): JOSE L COLON BORRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE RIUS RIVERA
ADJUNTAS PR
00601-2337
US

IV. Provider business mailing address

HC 8 BOX 300
PONCE PR
00731-9447
US

V. Phone/Fax

Practice location:
  • Phone: 787-829-4476
  • Fax:
Mailing address:
  • Phone: 787-829-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15,277
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: