Healthcare Provider Details

I. General information

NPI: 1306381991
Provider Name (Legal Business Name): JESSENIA COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F23 EXT JARDINES DE COAMO
COAMO PR
00769
US

IV. Provider business mailing address

EXT.JARDINES DE COAMO F23
COAMO PUERTO RICO
00769
UM

V. Phone/Fax

Practice location:
  • Phone: 787-426-8752
  • Fax:
Mailing address:
  • Phone: 787-426-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number72519
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: