Healthcare Provider Details

I. General information

NPI: 1497469811
Provider Name (Legal Business Name): ANA MARIA COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXTENSION MARIANI CALLE ZENO GANDIA #7653
PONCE PR
00717
US

IV. Provider business mailing address

EXTENSION MARIANI CALLE ZENO GANDIA #7653
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-246-4399
  • Fax:
Mailing address:
  • Phone: 787-246-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7142
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7142
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: