Healthcare Provider Details

I. General information

NPI: 1295155737
Provider Name (Legal Business Name): EDWIN COLON COLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SERGIO CUEVAS BUSTAMENTE STREET #550, AVE DOMENECH
SAN JUAN PR
00918
US

IV. Provider business mailing address

PLAZA DEGETAU 1 CLL SHUFFORD STE 109 PMB 247
CAGUAS PR
00727
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-8383
  • Fax: 787-763-9758
Mailing address:
  • Phone: 787-981-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25178
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: