Healthcare Provider Details

I. General information

NPI: 1558475137
Provider Name (Legal Business Name): JANINE S COLON GENERAL PRACTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOLAR67,LOCAL B CARR 691 COMUNIDAD LOS PUERTOS
DORADO PR
00646-9998
US

IV. Provider business mailing address

PO BOX 441
AIBONITO PR
00705-0441
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-3684
  • Fax: 787-796-8642
Mailing address:
  • Phone: 787-626-3684
  • Fax: 787-626-3684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13270
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: