Healthcare Provider Details

I. General information

NPI: 1023012630
Provider Name (Legal Business Name): ANGEL WILFREDO HERNANDEZ COLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INSTITUTO SAN PABLO #66 SANTA CRUZ ST. STE 501
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

INSTITUTO SAN PABLO #66 SANTA CRUZ ST . STE 501
BAYAMON PR
00961-7050
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-1085
  • Fax: 787-785-2469
Mailing address:
  • Phone: 787-787-1085
  • Fax: 787-785-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3248
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: