Healthcare Provider Details

I. General information

NPI: 1487119723
Provider Name (Legal Business Name): IRIS M COLON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 79.4 1111 AVE MIRAMAR
ARECIBO PR
00612
US

IV. Provider business mailing address

1334 CALLE JOSE CELSO BARBOSA
QUEBRADILLAS PR
00678-2386
US

V. Phone/Fax

Practice location:
  • Phone: 787-446-2822
  • Fax:
Mailing address:
  • Phone: 787-446-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4573
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: