Healthcare Provider Details

I. General information

NPI: 1447564620
Provider Name (Legal Business Name): NYDIA YMAR COLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 WASHINGTON STREET STE 703 ASHFORD MEDICAL CENTER
SAN JUAN PR
00907
US

IV. Provider business mailing address

1294 CALLE JUAN BAIZ PARQUE DE LA VISTA II APT 137-D
SAN JUAN PUERTO RICO
00924
UM

V. Phone/Fax

Practice location:
  • Phone: 787-725-9708
  • Fax: 787-721-6995
Mailing address:
  • Phone: 787-645-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18567
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: