Healthcare Provider Details

I. General information

NPI: 1629540240
Provider Name (Legal Business Name): ROSA V COLON TS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROSA VIVIANA COLON PARRILLA

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA CRUZ B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6902
US

IV. Provider business mailing address

URB SANTA CRUZ B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6902
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-9196
  • Fax: 787-625-6124
Mailing address:
  • Phone: 787-780-9196
  • Fax: 787-625-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9507
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier9507
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerJUNTA DE LICENCIAMIENTO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: