Healthcare Provider Details

I. General information

NPI: 1295669679
Provider Name (Legal Business Name): LUIS H COLON PAGAN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CALLE ENRIQUE GONZALEZ W APT 1
GUAYAMA PR
00784-5351
US

IV. Provider business mailing address

24 CALLE ENRIQUE GONZALEZ W APT 1
GUAYAMA PR
00784-5351
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-1683
  • Fax:
Mailing address:
  • Phone: 787-505-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6630
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: