Healthcare Provider Details

I. General information

NPI: 1598768061
Provider Name (Legal Business Name): VICTOR J COLON-VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE HOSPITAL HIMA SUITE 122 AVE LUIS MUNOZ RIVERA
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 7947
CAGUAS PR
00726-7947
US

V. Phone/Fax

Practice location:
  • Phone: 787-747-2530
  • Fax: 787-747-2530
Mailing address:
  • Phone: 787-747-2530
  • Fax: 787-747-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number13117
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: