Healthcare Provider Details

I. General information

NPI: 1851593057
Provider Name (Legal Business Name): JORGE L SURIA-COLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C1 CALLE NOGAL CAPARRA HILLS
GUAYNABO PR
00968-3106
US

IV. Provider business mailing address

C1 CALLE NOGAL CAPARRA HILLS
GUAYNABO PR
00968-3106
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-4640
  • Fax:
Mailing address:
  • Phone: 787-787-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number4013
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: