Healthcare Provider Details

I. General information

NPI: 1962594366
Provider Name (Legal Business Name): JOSE ANTONIO COLON VILLAFANE M:D:
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 438 KM0.1 DOMINGO RUIZ HC-01 B0X 4829
SABANA HOYOS PR
00688-9714
US

IV. Provider business mailing address

STREET 438 KM0.1 DOMINGO RUIZ HC-01 B0X 4829
SABANA HOYOS PR
00688-9714
US

V. Phone/Fax

Practice location:
  • Phone: 787-881-9271
  • Fax: 787-881-9271
Mailing address:
  • Phone: 787-881-9271
  • Fax: 787-881-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12039
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: